Guides New York and Long Island
Timely filing limits for New York payers, by plan
The short answer
New York-regulated plans must give you at least 120 days from the date of service to file, and Medicaid managed care at least 90. Self-funded plans, Medicare, eMedNY and TRICARE follow their own clocks, listed below with sources.
New York sets a floor for commercial plans it regulates: Insurance Law §3224-a(g) gives providers at least 120 days after the date of service to submit a claim, unless the contract gives more time. Medicaid managed care and Child Health Plus contracts can be shorter, but not under 90 days (NY Ins. Law §3224-a, as of November 2026). Self-funded employer plans, traditional Medicare, eMedNY fee-for-service Medicaid and TRICARE have their own deadlines. Most payers also have separate, shorter windows for corrected claims and appeals.
The table below lists each deadline with its source. The note under it says how to read it.
The table
Read in November 2026 from each payer’s own manual or regulation. A blank-style entry (“not published, ask the plan”) means we couldn’t find the number in a public document. Your participation agreement can override every commercial row, so check it.
| Payer | Initial claim | Corrected claim | Reconsideration or appeal | Source |
|---|---|---|---|---|
| Medicare (traditional) | 1 calendar year from date of service | Reopening for any reason within 1 year of the initial determination | Redetermination within 120 days of receiving the initial determination | 42 CFR 424.44, 405.980, 405.942 |
| NY Medicaid fee-for-service (eMedNY) | 90 days from date of service, later only with a delay reason code; 2-year hard stop | Adjustment within 60 days of notification | Waiver request for claims over 2 years: within 60 days of the remittance date | eMedNY General Billing, v2025-1 |
| NYSHIP Empire Plan (UnitedHealthcare medical) | 120 days after the end of the calendar year of service, unless your contract says otherwise | Not published, ask the plan | Not published in the Empire Plan supplement, ask the plan | UHC 2026 Administrative Guide, Empire Plan supplement |
| Anthem Blue Cross Blue Shield (NY commercial) | Set by your provider agreement | Not published, ask the plan | Reconsideration within 180 days of the EOP; appeal within 90 days of the reconsideration decision | Anthem NY Provider Manual, eff. Dec 1, 2024 |
| UnitedHealthcare (commercial) | Set by your agreement | Same limit as the initial claim | Within 12 months of the original EOB or PRA | UHC 2026 Administrative Guide |
| Oxford (UnitedHealthcare), New York | 120 days from date of service; 90 days from the primary EOB when coordination of benefits caused the delay | Not stated in the Oxford supplement, ask the plan | 12 months from the original EOB or PRA, covering both reconsideration and appeal | UHC 2026 Administrative Guide, Oxford supplement |
| UnitedHealthcare Community Plan (NY Medicaid) | Set by your agreement; a rejected claim not corrected within 90 days of service is denied as late | Resubmission must be received within 45 business days, per the manual’s dispute grid | Reconsideration within 90 business days; formal appeal within 60 calendar days | UHC Community Plan NY Care Provider Manual, 2026 |
| Aetna (NY fully insured) | 120 days from date of service, unless a longer period is agreed | Not published, ask the plan | 180 days is Aetna’s stated standard for disputes, with state exceptions | Aetna State Supplement, 7/26, Aetna disputes and appeals |
| Cigna Healthcare | 90 days participating, 180 days out of network, longer where the law requires | Not published, ask the plan | 180 calendar days from the payment or denial notice, or the last adjustment | Cigna, when to file, Cigna appeals |
| EmblemHealth | Participating: 120 days from date of service or the primary payer’s EOP; self-funded groups may set their own | Not published, ask the plan | Through the dispute resolution chapter for the line of business | EmblemHealth timely filing |
| Healthfirst | Set by your agreement; never paid if filed more than 180 days after service | Same rules as a new claim | Reconsideration within 90 days of the EOP paid date; dispute within 60 days of the reconsideration letter | Healthfirst NY Provider Manual, Nov 2026 |
| Fidelis Care (Medicaid, CHP) | 90 days | Within 60 days of the remittance advice | Claims appeal within 60 days of the remittance advice | Fidelis Care Provider Manual, v26.1 |
| 1199SEIU Benefit Funds | 90 days for participating providers; may deny after 1 year without proof of timely filing | Not published, ask the plan | Not published, ask the plan | 1199SEIU claims and reimbursement |
| TRICARE | 1 year after the services | A claim returned for more information: the later of 1 year after service or 90 days from the return | Not covered here, see your regional contractor | 32 CFR 199.7(d) |
Other Medicaid managed care plans and Medicare Advantage plans aren’t in this table. For those, the plan’s provider manual and your agreement are the sources.
How to read the table
The state floor applies only to New York-regulated plans. Section 3224-a(g) binds insurers and HMOs licensed in New York. It doesn’t reach self-funded employer or union plans, even when a carrier you know processes their claims. EmblemHealth says this directly: self-funded groups “may set their own claim filing limits” and those override its published ones. 1199SEIU’s provider site says state insurance laws on overpayment recovery don’t apply to its funds because they “are not insurance companies”, and its participating limit is 90 days. Check the ID card at every visit. NY DFS tells consumers that “fully insured” on the card means New York law applies (DFS surprise medical bills).
National numbers aren’t the New York number. Cigna’s page says 90 days for participating providers, then lists an exception where “applicable law requires a longer filing period”. On a New York fully insured Cigna plan, §3224-a(g) is that law. Aetna’s New York supplement prints the 120-day rule outright.
“Set by your agreement” means read your contract. Anthem, UnitedHealthcare commercial and Healthfirst publish no single number; the contract governs. If you don’t have a copy of each participation agreement and its fee schedule, ask the plan’s provider relations team for one.
Corrected claims and appeals run on separate, shorter clocks. Fidelis gives 60 days from the remittance for corrected claims. eMedNY gives 60 days for adjustments. UnitedHealthcare says a corrected claim must arrive within the same limit as the original, counted from the date of service, so a claim corrected on day 100 of a 90-day limit is late even though the original was on time.
How the clock counts
Date of service, not date sent. Most clocks start on the date of service, or the last date of service for a span. Oxford’s supplement says the deadline is “based on the date of service on the claim”, not when it was sent or received.
Secondary claims start from the primary’s EOB. When another payer pays first, the clock usually restarts from the primary payer’s decision, but each plan words it differently:
| Payer | When the secondary clock starts |
|---|---|
| EmblemHealth | 120 days from the primary carrier’s EOP issue date |
| Oxford | 90 days from the primary carrier’s EOB, when coordination of benefits caused the delay |
| Cigna | From the processing date on the primary carrier’s EOB or EOP |
| UHC Community Plan NY | From the date on the other carrier’s payment correspondence |
| eMedNY | Delay reason code 7: 30 days from when submission came within your control |
Section 3224-a(g)(2) also keeps any longer coordination-of-benefits periods that already existed under New York law or regulation.
A rejected claim doesn’t count as filed. UnitedHealthcare says rejected claims “are not proof of timely filing”. Anthem says the claim must show as accepted on the acceptance report. Healthfirst treats a resubmitted rejected claim as a new claim. If a clearinghouse rejection sits in a queue for six weeks, those six weeks count against your limit.
Retroactive eligibility. eMedNY delay reasons 1 and 8 give 30 days from notice when eligibility was unknown or backdated. Healthfirst gives 60 days from notification of an eligibility determination. Keep the notice that shows the date you learned about the coverage.
Proof of timely filing
When a claim is denied as late and you believe it wasn’t, the plan will ask for proof. What counts varies:
- UnitedHealthcare wants the submission date, the acceptance date, the patient, the date of service and the provider. It accepts an EDI report, a billing system statement, or another carrier’s EOB or denial letter.
- Anthem accepts a claim copy with a computer-printed filing date, a fax confirmation, a billing system printout with set fields, a Level 2 or clearinghouse acceptance report showing the claim as accepted, or an Anthem letter requesting information.
- Healthfirst asks for a clearinghouse report and says it doesn’t accept printouts from your own billing software, or certified mail receipts that can’t be tied to the claim.
The safe common answer is the payer-level acceptance report (the 277CA, or your clearinghouse’s payer acceptance report) showing the patient, the date of service and the accepted date. Save it for every claim, not just the ones in trouble.
Late, but maybe still payable
New York gives participating providers one more option on fully insured plans. Under §3224-a(h), you can ask the plan to reconsider a claim denied only for late filing. It must pay if the delay came from an unusual occurrence and you have a pattern of filing on time. The plan may reduce payment by up to 25%, and the right ends 365 days after the date of service. Aetna’s New York supplement gives examples of an unusual occurrence, such as a disaster outside your control. EmblemHealth notes that payment may be reduced by up to 25% when a late-filing denial is overturned.
Don’t build your workflow around this option. It only works if your filing record is otherwise clean.
Prevention: a weekly routine
- Run an unbilled report every week. List every encounter with no claim, sorted by date of service. Anything older than 30 days needs an owner and a reason.
- Work clearinghouse rejections daily. A rejection stops nothing.
- Set alerts per payer, not one house rule. A 90-day rule for everything is too loose for eMedNY corrections and Fidelis corrected claims, and too strict for Medicare.
- Track corrected claims against the original date of service. Several plans count from service, not from the denial.
- Flag secondary claims the day the primary EOB posts. Bill the secondary that day, with the EOB attached where the plan requires it.
- Record “fully insured” or “self-funded” at check-in. It tells you whether the 120-day floor applies.
Marlow’s free billing audit lists your claims closest to a filing deadline, from your own 835s and AR aging. For the rest of New York’s rules, see New York billing rules other states don’t have.
Sources
- NY Insurance Law §3224-a
- 42 CFR 424.44 (Medicare claim filing time limits)
- 42 CFR 405.942 (Medicare redetermination time frame)
- 42 CFR 405.980 (Medicare reopenings)
- eMedNY: Information for All Providers, General Billing (version 2025-1)
- UnitedHealthcare 2026 Care Provider Administrative Guide (commercial, Oxford and Empire Plan supplements)
- UnitedHealthcare Community Plan New York Care Provider Manual, 2026
- Anthem Blue Cross and Blue Shield New York Provider Manual
- Aetna Provider Manual State Supplement
- Aetna: Disputes and appeals
- Cigna Healthcare: When to file claims
- Cigna Healthcare: Appeals and disputes
- EmblemHealth: Claims submission, timely filing
- Healthfirst New York Provider Manual
- Fidelis Care Provider Manual (Medicaid, CHP)
- 1199SEIU Benefit Funds: Claims and reimbursement
- 32 CFR 199.7 (TRICARE claims filing deadline)
- NY DFS: Surprise medical bills
General information, not advice on a specific claim, contract or legal question. Rules and rates change; check the linked sources for the current version.