What is Timely filing?
The payer’s deadline for receiving a claim, after which it will not be adjudicated at all.
Definition
Every payer sets a window — commonly 90 days to a year from the date of service, defined by contract — within which a claim must be received. Miss it and the payer denies without evaluating the claim on its merits.
The window runs on receipt, not on submission, which is why a claim rejected at the clearinghouse is the most dangerous kind: it was never received, the clock never stopped, and nothing in the payer’s system will ever report on it. Most participating agreements also prohibit billing the patient for a claim lost to the provider’s own filing delay, which makes a timely-filing denial a total loss on a service already delivered.
Why it matters
This is the one denial category with no clinical or coding defence. It is entirely a process failure, and it is entirely preventable.
Denial codes to know
Related terms
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