Medicaid: Timely Filing, Appeals, and Billing Guide
Medicaid is the joint federal-state program covering low-income individuals, administered separately by each state under federal minimums. Because every state runs its own program (and often multiple managed-care plans), timely-filing limits vary widely — commonly 90 to 365 days from the date of service — so the controlling rule is always your state Medicaid agency or MCO contract, never a national number.
- Type
- Joint federal-state; FFS + managed care (MCO)
- Timely filing
- Varies by state (~90-365 days)
- Appeal deadline
- State/MCO specific
- Portal
- State Medicaid portal + MCO portals
What is Medicaid?
Medicaid is a joint federal-state program that covers low-income children, pregnant patients, adults, seniors, and people with disabilities. The federal government sets minimum standards and shares the cost, but each state designs and runs its own program — different names (Medi-Cal, TennCare, Apple Health), different covered benefits, different provider manuals, and different rules.
Most states deliver Medicaid through managed-care organizations (MCOs) like Centene, Molina, and regional plans, rather than paying claims directly. So "billing Medicaid" usually means billing a private MCO under a state contract.
What are Medicaid\'s timely filing and appeal deadlines?
There is no national number. Filing windows commonly range from 90 days to 12 months depending on the state and MCO. Appeal deadlines are state- and plan-specific and often shorter than commercial windows.
| Path | Filing | Appeal |
|---|---|---|
| State fee-for-service | State manual (~90-365 days) | State agency process |
| Managed care (MCO) | MCO contract | MCO appeal, then state fair hearing |
Fee-for-service vs managed care — how do you bill?
Fee-for-service Medicaid claims go to the state agency's fiscal agent. Managed-care claims go to the assigned MCO with its own payer ID, portal, and policies. A member's coverage can be split — carved-out services (behavioral health, dental, transportation) may go to a different vendor than the medical MCO.
Because Medicaid is the payer of last resort, always resolve coordination of benefits first: bill Medicare or commercial primary, then Medicaid with the primary EOB.
What billing quirks should you watch?
- Payer of last resort. Bill all other liable payers before Medicaid, every time.
- Eligibility can change monthly. Re-verify the date-of-service MCO, not today's.
- State-specific everything. Manuals, deadlines, and appeal paths differ by state and MCO.
- Carve-outs. Behavioral, dental, and transportation may route to separate vendors — see Centene and Molina.
Frequently asked questions
It varies by state. Each state Medicaid agency sets its own filing window (a common range is 90 days to 12 months), and each managed-care organization contracted with the state can set its own within federal limits. There is no national Medicaid filing rule — confirm the number in your state provider manual and each MCO agreement you participate in.
Federal law requires Medicaid to pay only after all other liable third parties — commercial insurance, Medicare, liability carriers — have paid. So Medicaid claims almost always require coordination of benefits: bill the primary payer first, then submit to Medicaid with the primary EOB attached. Skipping this triggers denials and can create overpayment recovery later.
Appeal rules depend on whether the claim is fee-for-service (appeal to the state agency) or managed care (appeal to the MCO first, then a state fair hearing). Deadlines and processes are state-specific and often shorter than commercial windows. Check the state provider manual and the specific MCO contract; the mailing address and portal differ for each MCO.
Sources & further reading
Reviewed by the ImmediCare Solutions RCM team
Certified billers and coders handling claims across 50+ specialties nationwide. This entry is reviewed against current payer policy and CMS rules. Last review: Jul 5, 2026.
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