Ambetter Deadline Calculator
Pick the state, then enter the date of service. Add the date on the EOP or denial to see the reconsideration deadline.
Filing limits from Ambetter's provider quick reference guide for each state (2026). Reconsideration window from Ambetter's Kansas guide; other states may differ. For any other payer, use the TFL and AFL calculator.
Ambetter Timely Filing Limit by State
Ambetter sets its filing limit state by state. Its 2026 provider quick reference guides show 180 days from the date of service in 21 states, with shorter limits in four: Arizona and South Carolina (120 days), Texas (95 days) and Tennessee (90 days).
| State | Timely filing limit | Provider services |
|---|---|---|
| Alabama | 180 days from date of service | 1-800-442-1623 |
| Arizona | 120 days from date of service | 1-866-918-4450 |
| Arkansas | 180 days from date of service | 1-877-617-0390 |
| Florida | 180 days from date of service | 1-877-687-1169 |
| Georgia | 180 days from date of service | 1-877-687-1180 |
| Illinois | 180 days from date of service | 1-855-745-5507 |
| Indiana | 180 days from date of service | 1-877-687-1182 |
| Iowa | 180 days from date of service | 1-833-919-3213 |
| Kansas | 180 days from date of service | 1-844-518-9505 |
| Kentucky | 180 days from date of service | 1-833-705-2175 |
| Louisiana | 180 days from date of service | 1-833-635-0450 |
| Michigan | 180 days from date of service | 1-833-993-2426 |
| Mississippi | 180 days from date of service | 1-877-687-1187 |
| Missouri | 180 days from date of service | 1-855-650-3789 |
| Nebraska | 180 days from date of service | 1-833-890-0329 |
| Nevada | 180 days from date of service | 1-866-263-8134 |
| New Jersey | 180 days from date of service | 1-844-606-1926 |
| North Carolina | 180 days from date of service | 1-833-863-1310 |
| Ohio | 180 days from date of service | 1-877-687-1189 |
| Oklahoma | 180 days from date of service | 1-833-492-0679 |
| Pennsylvania | 180 days from date of service | 1-833-510-4727 |
| South Carolina | 120 days from date of service | 1-833-270-5443 |
| Tennessee | 90 days from date of service | 1-833-709-4735 |
| Texas | 95 days from date of service | 1-877-687-1196 |
| Washington | 180 days from date of service | 1-877-687-1197 |
All of these states use payer ID 68069 for electronic claims, and paper claims go to P.O. Box 5010, Farmington, MO 63640-5010. Your contract can set a different limit, so check it if you are in network.
Reconsiderations and Appeals
After a denial or a payment you disagree with, Ambetter uses two levels. Ambetter's Kansas guide (Ambetter from Sunflower Health Plan) sets these rules:
| Level | Deadline | Decision time |
|---|---|---|
| Level I: reconsideration | 180 calendar days from the original EOP or denial | 30 calendar days, by revised EOP |
| Level II: appeal (claim dispute) | 180 calendar days from the most recent EOP | 30 calendar days, by letter |
A reconsideration is required before an appeal. Other states set their own windows, so confirm yours in your state's Ambetter provider manual.
The Grace Period Trap
Ambetter is a Marketplace plan. Under federal rules, members who get premium tax credits have a three-month grace period when they stop paying premiums. The plan must pay claims for services in the first month, but it can hold claims from the second and third months. If the member never pays, coverage ends after the first month and those held claims are denied, often as CO-27.
When eligibility shows a member in a grace period, collect what you can at the visit or reschedule non-urgent care. See our guide to verifying insurance eligibility.
Tips to Avoid Ambetter Denials
- Check eligibility at every visit. Marketplace coverage changes often.
- Track each state's limit separately if you see patients from more than one state.
- Send corrected claims within your state's window and reference the original claim number.
- Save clearinghouse acceptance reports as proof of timely filing.
- Use the right local plan name and payer ID on the claim.
Compare with other payers in our timely filing calculator, or read the timely filing limits guide.
Sources: Ambetter provider toolkit quick reference guides for each state listed (ambetterhealth.com, 2026); Ambetter from Sunflower Health Plan, Claim Reconsideration and Appeal Quick Reference Guide; 45 CFR 156.270 (grace period for enrollees receiving premium tax credits).
Frequently Asked Questions
Reviewed 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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