Home-care timely filing limits: the deadline that quietly writes off real revenue.
A clock runs on every claim from the date of service. Miss it, and a claim for real work stops being collectible. In home care the clock is shorter than most owners think, and it rarely runs out because a claim was ignored. It runs out because a claim sat behind an authorization gap, an EVV mismatch, or a denial nobody reworked.
Three clocks, and the shortest one wins
Federal Medicaid sets an outer ceiling of 12 months from the date of service under 42 CFR 447.45. Almost every state Medicaid program then sets a shorter limit of its own, commonly 90, 120, 180, or 365 days. Managed-care plans layer contract limits on top that are often tighter still.
Your effective deadline for any given claim is the shortest of the federal ceiling, the state Medicaid limit, and the plan contract. The 12-month federal number is almost never the real deadline. Working from it is one of the most expensive mistakes in a home-care billing shop.
What a CO-29 denial is telling you
On the remittance advice, a timely-filing denial appears as group code CO with CARC 29, "the time limit for filing has expired." Once CO-29 fires, no administrative appeal on its own recovers the claim. The window is closed and the payer treats the balance as a contractual write-off.
The exception is a claim that was submitted on time but the payer failed to process. That is a different fact pattern and a different appeal, and it needs proof of the timely original submission, not a rebuttal of the deadline itself.
Why on-time visits still miss the window
The clock runs from the date of service, not from when anyone noticed the claim was stuck. A visit gets held for a missing authorization, parked behind an EVV mismatch, denied once and never reworked, or lost between the EMR and the clearinghouse. It ages while it sits.
By the time the aged AR report surfaces the balance, the deadline is often days away or already past. The claim was never ignored. It was invisible.
Which timely-filing denials you can still recover
- ›A claim submitted on time that the payer failed to process, with proof of the timely original submission from clearinghouse acceptance logs or portal transmission records.
- ›Documented state exception categories, such as retroactive member eligibility or a payer processing error, submitted with the specific evidence the state or plan requires.
- ›Payer administrative errors, including a claim rejected in error at the front end where the payer's own system logs the fault.
How agencies stop bleeding to the clock
Know the real per-payer deadline in one place, not scattered across payer manuals nobody reads. Watch the aging by days remaining, not by month bucket, because a 45-day-old claim under a 90-day contract is not the same problem as one under a 365-day contract. Rework recoverable denials while they are still in window, and treat every CO-29 as a diagnostic finding on the upstream process that let the claim age.
Plain answers, on the record.
Collect is money you never captured. Cover is money a payer can still take back.
Reeve reports the two separately and never adds them together, because only one of them is yours to go and get. The Margin Review reads both on your own export and costs nothing.
One pass over your own export, in your browser. The findings are yours to keep, with no obligation.
The recovery lane. Care you delivered and never billed, units short of what was authorized, lines paid under the published rate.
Everything in Collect, plus the exposure lane. Retired codes, authorizations at the end of their period, care delivered past what was approved.
Month to month, no annual contract. Read-only in every tier. Run the free review.
See which claims are running out of clock.
The Margin Review sorts your open denials and unbilled visits by days remaining under the actual per-payer deadline, so the recoverable ones get worked before the window closes.