What is Centene / Ambetter / Health Net's timely filing limit for initial claims?

Centene / Ambetter / Health Net enforces an initial claim timely filing deadline of 95 to 180 calendar days from Date of Service (state dependent).

How many days do you have to appeal a denial with Centene / Ambetter / Health Net?

Appeals and payment disputes with Centene / Ambetter / Health Net must be filed within 90 to 180 calendar days from initial denial notice.

What is the secondary claim timely filing limit for Centene / Ambetter / Health Net?

Secondary claims for Centene / Ambetter / Health Net must be submitted within 90 days from primary EOB date.

Centene Medicaid Managed Care & ACA Exchange 95 Days Limit

Centene / Ambetter / Health Net Timely Filing Limit & Appeal Deadlines

Official filing rules, submission windows, appeal timeframes, and acceptable electronic clearinghouse proof for billing Centene / Ambetter / Health Net.

Initial Claim Limit

95 Days from DOS

Secondary Claim Limit

90 Days from EOB

Level 1 Appeal Limit

90 Days

Level 2 Dispute Limit

60 Days

1. Initial Claim Submission Deadline

95 to 180 calendar days from Date of Service (state dependent)

Clean electronic 837P or 837I claims must be received and acknowledged by Centene / Ambetter / Health Net within this window. If a claim is rejected on front-end clearinghouse validation (Level 2), it is not considered received by Centene / Ambetter / Health Net until corrected and successfully re-transmitted.

2. Specific Filing Rules for Centene

State Medicaid managed care contracts vary (Texas 95 days, Florida 180 days, Georgia 180 days).

Ambetter Marketplace plans generally enforce 180 calendar days.

Provider claim disputes must be submitted within 90 days of denial.

3. Accepted Proof of Timely Filing

Official Proof Required by Centene

Centene provider portal confirmation or EDI 277CA acceptance with Centene Payer ID (e.g. 68069).

Important: Screenshots from your internal billing software or electronic health record (EHR) showing the date a claim was created are not accepted by Centene as proof of submission. You must supply clearinghouse 277CA acceptance reports.

4. Appeal Letter Template for Centene

Use this standardized appeal letter to overturn a CO-29 timely filing denial when you have verifiable clearinghouse proof:

RE: Timely Filing Denial Appeal (CO-29)
Payer: Centene / Ambetter / Health Net
Patient Name: [Patient Name] | Member ID: [Member ID]
Date of Service: [Date of Service] | Claim ID: [Claim Number]
Billed Charges: $[Billed Amount]

Dear Appeals Coordinator,

We are submitting this formal appeal in response to the timely filing denial (CO-29) issued on the Explanation of Benefits dated [Remittance Date]. Under our participating agreement with Centene / Ambetter / Health Net, the timely filing limit is 95 calendar days from the date of service.

The original claim was electronically transmitted and received prior to the timely filing limit expiration. Enclosed please find Exhibit A: The clearinghouse Electronic Data Interchange (EDI) 277CA Claims Acknowledgment Report confirming successful gateway acceptance on [Date of Initial EDI Transmission] with Payer Claim Control Number [ICN / CCN].

Because this documentation constitutes conclusive objective proof of timely electronic submission, we respectfully request that the claim be reprocessed and approved for reimbursement.

Sincerely,
[Billing Manager / Practice Representative]
[Practice Name]
[Phone Number]