State Medical Billing Laws: Filing Deadlines & Rules

A state medical billing law sets three deadlines a practice can lose money to: how long a payer allows for filing a claim, how long the practice has to collect an unpaid patient balance, and whether a patient may be billed the difference when the provider is out of network. Federal law fixes the outer boundary on the first two. Under 42 CFR 447.45(d)(1), a state Medicaid agency must require providers to submit claims no later than 12 months from the date of service, and since 1 January 2022 the federal No Surprises Act (45 CFR Part 149) has barred balance billing for most emergency care and for out-of-network care delivered at an in-network facility.

States then tighten those limits, and the tightening is where claims are lost. Texas Medicaid requires claims within 95 days of the date of service (Texas Medicaid Provider Procedures Manual, Section 6); Illinois Medicaid allows 180 days (Illinois HFS); Medi-Cal allows six months following the month in which the service was rendered (California DHCS). A practice billing across state lines is working to three different clocks at once.

This reference currently details 3 states in depth - California, Illinois and Texas - covering statute of limitations on medical debt, Medicaid timely filing, and balance-billing rules with the governing statute named for each.