Dental timely filing limits by payer (2026)

Where the payer documents differ from the usual summary

• •Cigna: Publishes real public numbers — 90 days participating, 180 out-of-network, a 180-day mailed payment appeal — despite the folklore that everything sits behind the portal.
• •United Concordia: Publishes no public deadline at all: every reference guide sits behind the Highmark SSO login, and the guides are network- and state-specific even behind it.
• •Humana: The full dental provider manual is public — 15 months commercial, 12 months Medicare, and a 60-day refund window before recoupment starts.
• •UnitedHealthcare: State Medicaid manuals disagree with each other — 90 days (WI), 180 (NE), 120 (NY) — and the Wisconsin manual contradicts itself on the secondary-claim clock.

Payer-published windows

"Not extracted" means this pass did not verify a window — not that none exists. A payer's absence from this table means "not verified yet," not "no rule exists."

Verified cross-payer facts

Common questions

The clearinghouse bounced the claim — did that stop the clock?

No, and the test is acceptance rather than what the report was called. Under CMS's claims-processing manual a submission that fails front-end completeness or validity edits is not considered received, never gets a receipt date, and is not considered filed for timely-filing purposes; only a submission that passes those edits is accepted into the processing system and gets a permanent receipt date. Do not anchor on the word rejected: CMS itself uses it both for a submission that was never received and for an accepted claim that appears on the remittance advice. Ask instead whether the claim was accepted into adjudication and shows on a remittance. A bounce at your own clearinghouse never reached the payer at all. These are Medicare fee-for-service documents describing the mechanism; the deadline itself comes from your dental payer's contract and the applicable state statute.

We missed the deadline — can we appeal a timely-filing denial?

It depends on the payer, and on Medicare the answer is no: CMS states that a denial for filing after the timely-filing period is not an initial determination, so it is not subject to appeal. Commercial dental payers set their own route, and what moves those decisions is evidence rather than argument — proof the original claim was accepted on time, a documented wrong-payer-first trail, or a state statutory floor the contract deadline violates. Move fast on a bounced claim, too: returned submissions typically sit in temporary storage for 60 days or less before purging, after which there is no audit trail that the submission ever existed.

Which document actually sets the deadline?

It depends on who is paying, and there are three tiers rather than one. Medicare fee-for-service runs on a federal regulation — 42 CFR 424.44 requires the claim to be filed no later than one calendar year after the date of service, and that is not contractible. Medicaid runs on the state plan and 42 CFR part 447. State-regulated commercial and specialized dental plans run on the state statute or regulation that sets the floor, with the provider participation contract operating inside it. So "check the contract" is the right instinct for a commercial dental claim and the wrong place to look for a Medicare or Medicaid one.