Never miss a filing or appeal deadline across every payer.
Every claim is really carrying two or three clocks at once: the payer's timely filing window, the appeal window if it denies, and the state prompt-pay clock running against the payer. Track them separately and one always slips.
One claim, several clocks, one countdown
A single claim carries more than one deadline at the same time. Here is what that looks like when you put them on one view instead of three spreadsheets. Bars are illustrative.
Where a deadline goes to die
Follow one claim down the timeline. Each handoff is a place where the clock keeps running but the ownership does not.
Timely filing runs from date of service, not from when the claim is built. Medicare gives 12 months; many commercial contracts are far shorter. The window is already shrinking in coding and charge entry.
source: payer provider manualA claim that rejects at the clearinghouse was never received by the payer. Timely filing keeps counting. A rejection sitting unworked for two weeks is two weeks off the only clock that matters.
277CA / clearinghouse rejectThe claim gets reassigned, the biller changes, or it bounces from front-end to AR follow-up. This handoff is where silent aging happens: nobody restarts the clock because the clock never stopped.
the silent gapThe denial opens the appeal window, and it is usually tighter than the filing window. For Medicare, redetermination is 120 days from receipt of the initial determination. Miss it and the underlying claim is effectively closed.
appeal window opensLose the first level and the next clock is different again: Medicare reconsideration is 180 days, then 60 days for the ALJ level. Every step is its own deadline stacked on top of the last.
CMS Original Medicare appealsThe Medicare appeal ladder, by the clock
Original Medicare fee-for-service appeals. Each level runs from receipt of the prior decision. These windows are set in CMS regulation, not by the payer.
| Level | What it is | Deadline to file | Runs from |
|---|---|---|---|
| 1 | Redetermination (MAC) | 120 days | Receipt of the initial determination (MSN / RA) |
| 2 | Reconsideration (QIC) | 180 days | Receipt of the redetermination notice |
| 3 | ALJ hearing (OMHA) | 60 days | Receipt of the reconsideration notice |
| 4 | Medicare Appeals Council | 60 days | Receipt of the ALJ decision |
| 5 | Federal District Court | 60 days | Receipt of the Council decision (amount-in-controversy applies) |
State prompt-pay statutes
Timely filing is your deadline. Prompt-pay is the payer's. When you track it, a clean claim that sits too long can carry interest. A few real examples.
Windows and interest rules vary by state and plan type. Always confirm against the current statute and your payer contract.
Why deadlines age out silently
The deadline lives on the claim, so it survives every handoff
RecoveAR treats timely filing, the appeal window, and prompt-pay as attributes of the claim itself, calculated from the dates that actually start each clock. It does not matter who is working the account or how many times it transfers. The oldest live deadline is always the one you see first.
- Per-claim countdown that stacks filing, appeal, and prompt-pay clocks on one timeline
- Payer-specific filing limits and appeal windows loaded per contract, not guessed
- Medicare appeal ladder built in, from the 120-day redetermination onward
- Rejections and denials restart the right clock the moment they land
- Work queues sort by soonest deadline, so triage matches urgency
- Prompt-pay tracking flags when the payer owes you interest, not the reverse
Bring a payer mix and we will map the clocks that are quietly costing you.
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