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Insurance Payer Guides: Filing Limits, Appeals & Contacts

One page per payer — the timely filing limits, appeal deadlines, portals, and denial patterns you otherwise dig out of provider manuals at 4:45 on a Friday.

Why Payer-Specific Guides?

Medical billing rules are only half national. The other half — filing windows, appeal levels, claim reconsideration steps, portal quirks, payer IDs — changes with every insurance company, and sometimes with every plan inside one company. Billing UnitedHealthcare like it were Cigna produces denials that have nothing to do with your coding. These guides collect the payer-level facts billers actually look up: how long you have to file, how long you have to appeal, where claims go, and which denial patterns each payer is famous for. Every figure comes with the same caveat we use in our own billing work: contracts and plan documents override general rules, so treat these as the starting point and your contract as the law.

These pages pair with our timely filing calculator (deadline math from the date of service), the denial code library (what the remit is actually saying), and the appeal letter generator (the paperwork, drafted in a minute).

Payer Guides

TRICARE and Medicaid guides are next — added regularly. Fighting a payer problem right now? Our denial team works these daily.

Frequently Asked Questions

Are timely filing limits the same for every plan a payer offers?
No — that is the trap. One insurance company can run commercial plans at 90 days, Medicare Advantage plans at one year, and employer self-funded plans at whatever the plan document says. The payer guide gives you the typical values; your participation contract and the member plan decide the real one.
What is the difference between a reconsideration and an appeal?
Many payers require an informal reconsideration (a corrected-claim-style second look) before accepting a formal appeal with clinical documentation. Skipping the sequence gets the appeal rejected on procedure, not merit — each payer guide spells out the order.
Where do I find the payer ID for claims submission?
Payer IDs vary by clearinghouse and sometimes by plan within one company — the member ID card and your clearinghouse payer list are the sources of truth. Sub-brands (like UMR or Oxford under UnitedHealthcare) often use their own IDs.
Can I rely on these numbers in an appeal letter?
Use them to know the landscape, then cite your contract, the payer provider manual, and the plan document in the letter itself — those are the binding sources a reviewer must answer to.

Hassan Raza AwanReviewed by Hassan Raza Awan, Founder — 4+ years of hands-on U.S. medical billing experience. General billing information — verify against current CMS guidance and your payer contracts.

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