What is the deadline to submit Aetna claims?

The deadline to submit an Aetna claim depends on your specific plan type, starting generally from 90 days to 12 months from the date of service.

Deadlines by Plan Type

• Commercial In-Network Plans: 90 days from the date of service.
• Commercial Out-of-Network (Non-Participating) Plans: 12 months (365 days) from the date of service.
• Aetna Medicare Advantage: 12 months (365 days) from the date of service (set by federal minimum standards).
• Aetna Better Health (Medicaid Managed Care): 180 days from the date of service or discharge, though this can vary by state contract.
• Aetna Student Health: 120 days for in-network/participating providers, and up to 12 months for out-of-network reimbursement.
• Secondary Claims (Coordination of Benefits): Typically 60 days from the primary payer's Explanation of Benefits (EOB) date, or the plan default if longer.

Aetna's standard timely filing limit for in-network commercial claims is 90 days from the date of service, though deadlines vary significantly by plan type, contract, and state.

Timely Filing Limits by Plan Type

• In-Network Commercial: 90 days from the date of service (always check individual provider contracts for variances).
• Out-of-Network (Non-Par) Commercial: 12 months (365 days) from the date of service.
• Medicare Advantage: 12 months (365 days) from the date of service, following CMS guidelines.
• Medicaid Managed Care (Aetna Better Health): Typically 180 to 365 days depending on state-specific contracts and regulations.
• Coordination of Benefits (Secondary Claims): 60 days from the primary payer's Explanation of Benefits (EOB) date or 180 days from the date of service, whichever is later.

Dispute and Appeal Deadlines

• Reconsideration / Level 1 Dispute: Must be filed within 180 calendar days of the initial claim decision or denial notice.
• Level 2 Appeal: Must be filed within 60 calendar days of the reconsideration decision.
• Overturning Timely Filing Denials (CO-29): Requires submitting clear proof of timely submission, such as clearinghouse acceptance reports or electronic submission logs. You can review additional guidelines via Aetna Provider Appeals or check the Aetna Claims and Payment Portal.

Aetna's standard timely filing limit for in-network commercial claims is 90 days from the date of service, while out-of-network and Medicare Advantage plans allow 12 months.

Filing Limits by Plan Type

• Commercial In-Network: 90 days from the date of service (though your specific provider contract may vary).
• Commercial Out-of-Network (Non-Par): 12 months (365 days) from the date of service.
• Aetna Medicare Advantage (Part C): 12 months (365 days) from the date of service.
• Medicaid Managed Care (Aetna Better Health): Generally 180 days from the date of service, but this depends heavily on state contracts.

Special Claims & Exceptions

• Secondary Claims (COB): If Aetna is the secondary payer, the clock starts on the primary payer's Explanation of Benefits (EOB) date rather than the date of service (typically 60 days from the primary EOB or 180 days from the service date, whichever is later).
• Corrected Claims: Commercial in-network corrected claims typically allow 90 days from the original remittance date, while Medicare Advantage allows 180 days.
• Appeals: Standard claim-payment disputes or Level 1 reconsiderations generally must be filed within 180 days of the initial decision, though state-specific laws can change this window.

Several major health insurance companies enforce a standard 90-day timely filing limit from the date of service for in-network or commercial claims.

Major Insurances with 90-Day Limits

• Aetna: Standard in-network commercial claims generally require submission within 90 days.
• UnitedHealthcare (UHC): Enforces a 90-day baseline for most participating commercial network claims.
• Cigna: In-network participating providers must submit claims within 90 days.
• Anthem Blue Cross: Contracted commercial and Medicare Advantage professional claims carry a 90-day limit in many regions.
• Humana: Commercial lines often enforce a 90-day window from the date of service unless state rules dictate otherwise.
• State Medicaid Plans: Certain states (such as New York) cap initial Medicaid claim submissions at 90 days.

The standard grace period for individual health insurance plans—including those purchased through the Marketplace/Obamacare—is typically 3 months if you have already paid at least one full month's premium during the benefit year. For standard commercial or employer-sponsored group health plans, the typical grace period is usually 30 to 31 days depending on your specific state regulations and contract terms.

Key Details on Health Insurance Grace Periods

• Marketplace Plans (ACA): If you receive advance payments of the premium tax credit, federal rules mandate a 90-day (3-month) grace period before your policy can be terminated for nonpayment.
• Employer-Sponsored / Group Plans: Usually features a shorter grace period of 30 or 31 days from the premium due date.
• During the Grace Period: Your coverage generally remains active, though claims may be pended (held) until the overdue premium is paid in full. If payment is not made before the grace period ends, your policy will be officially canceled back to the last paid date.