Legal Reference Guide

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; Illinois Medicaid allows 180 days; Medi-Cal allows six months following the month in which the service was rendered. A practice billing across state lines is working to three different clocks at once.