Aetna Timely Filing Limit: 12 Months Out of Network, Your Contract In Network

Search for Aetna’s timely filing limit and you’ll find 90 days, 120 days, 180 days and 12 months. Most of the pages giving those numbers don’t say where they came from.

Aetna’s own documents are clearer, and less tidy. Out of network, the standard limit for medical claims is 12 months. In network, the claims pages of Aetna’s provider manual give no number at all. They send you to your agreement.

Here is what Aetna does publish: the out of network limit, the rules for Texas and New York, the two dispute clocks, Medicare Advantage, and the Aetna Better Health plans, which set their own limits state by state.

Aetna timely filing at a glance

Out of network: 12 months

Aetna announced the cut in the September 2021 issue of OfficeLink Updates, its provider newsletter. The standard limit for nonparticipating providers went “from 27 months to 12 months for traditional medical claims,” starting January 1, 2022.

Dental claims stayed at 27 months. Aetna said the new limit would “Match Centers for Medicare & Medicaid Services (CMS) standards.” It also said: “All policy exceptions to timely filing today will apply after this change and will be supported as they are today.”

The notice doesn’t list those exceptions. If a late claim has a real reason behind it, ask Aetna before you write it off.

It also doesn’t say what the 12 months count from. Medicare counts its 12 months from the date of service, as the proof of timely filing guide explains. Count from there, and don’t leave a claim for the last month.

In network: the number is in your agreement

Aetna’s provider manual, the June 2026 edition, uses its claims pages to explain how to submit, not when. Its dispute rules say a dispute “Must be submitted within contractual timeframes.”

Its opening pages say which document wins: “The policies and information stated in this manual should align with the terms of your agreement with us. If they don’t, the terms of your agreement govern and control.”

That is why the numbers online disagree. A participating provider’s limit comes from the contract, so 90, 120 or 180 days can each be right for somebody. None of them is a rule Aetna publishes for everyone.

To find yours:

• Read the agreement. Look for the section on claims submission or timely filing, and check any amendment since.
• Ask Aetna to confirm it in writing if you can’t find the agreement. Your network contact is the place to start.
• Check your state. Texas and New York set their own clocks, covered next.

Until you have yours in writing, bill within 90 days of the date of service. It’s the lowest of the numbers in circulation, so it’s the safe one to work to.

Texas and New York

Texas. Aetna’s December 2022 OfficeLink Updates moved Texas claims to the state’s 95 day rule in 2023: “All claims must be sent within 95 days of the date of service(s), unless you are legally unable to notify us.” The same notice says: “This policy update does not apply to provider contracts with specific filing requirements.”

The 95 days come from the Texas Insurance Code. Under it, a provider who misses the deadline “forfeits the right to payment,” unless an exception applies.

New York. Aetna’s state supplement says “Providers must initially submit claims within 120 days after the date of the service,” unless your agreement allows more or the law requires a different time frame.

A participating provider can still ask Aetna to reconsider a New York claim denied only for being late. Aetna has to pay it if the delay came from an unusual occurrence outside your control, like a flood, and you have a pattern of filing on time. It can cut the payment by up to 25 percent.

That right has an end date. It “shall not apply to a claim submitted 365 days after the service.”

State laws like these generally reach fully insured plans, not self funded employer plans, and Aetna administers many self funded plans. On those, your agreement and the plan decide.

Corrected and secondary claims

Aetna’s manual says you can submit claims on Availity at no charge, “including COB claims and corrected and voided claims.” It doesn’t give either kind a window of its own.

So treat a correction as due inside your original filing limit, and fix claims early. If the limit has passed on a claim you filed on time, ask Aetna whether to send a reconsideration instead. That clock runs 180 days from the claim decision.

Send a correction as a replacement, not a new claim. On an electronic claim, that means frequency code 7, or 8 to void, with Aetna’s claim number from the original. Sent without them, it can come back as a duplicate.

For secondary claims, the manual says Aetna coordinates benefits “as allowed by state or federal law,” and by the member’s plan where no law applies. It sets no separate clock. Send the secondary claim as soon as the primary payer’s remittance posts.

Reconsiderations and appeals

Aetna has two levels. In its words: “We offer two ways to dispute a claim decision: with a reconsideration or an appeal.”

• Reconsideration. “File your reconsideration within 180 calendar days of the initial claim decision.” Most get an EOB or letter back within 30 business days.
• Appeal. “File your appeal within 60 calendar days of the reconsideration decision.” Aetna sends its decision within 60 calendar days of receiving the appeal.

The second clock is the one that catches people. It’s a third the length of the first.

July 18 is a Saturday. Aetna’s page doesn’t mention weekends, so file by Friday, July 17.

Some disputes skip the first level and go straight to appeal, including some claims under state law and Medicare review decisions for nonparticipating providers. Then the window is 180 days for commercial and Medicare, or 65 days for Medicare noncontracted providers.

Fully insured plans in some states allow more time to dispute a payment. Aetna’s state exceptions page lists them. Arizona allows 1 year, Maryland 365 days, and Georgia 24 months from the date of service or discharge.

On Availity, two rules matter. “A claim must be in Finalized status before you can dispute it.” And “Disputes that remain in an ‘Initiated’ status are not submitted to the Payer.” A dispute you started but never submitted hasn’t reached Aetna, and its deadline is still running.

By mail or fax, an appeal needs Aetna’s dispute and appeal form. Use it for a reconsideration too, so nothing is missing. Send reconsiderations to the address on the EOB or denial letter. Commercial appeals go to Aetna Provider Resolution Team, PO Box 14020, Lexington, KY 40512.

Proof that a claim was on time

Aetna’s pages don’t list the proof it accepts for a claim it calls late. Keep the 277CA for every claim you send. It is Aetna’s own acknowledgment that it accepted the claim, and when. A 999 from your clearinghouse proves less: only that the clearinghouse got the file. The proof of timely filing guide explains the difference.

A claim Aetna counts as late comes back as CO-29. The CO-29 guide covers which of those denials can be won.

Aetna Medicare Advantage

For Aetna’s Medicare Advantage plans, a contracted provider’s filing limit is in the agreement. Out of network, work to Aetna’s 12 month standard, the one it set to match CMS.

Contracted providers dispute through the same two levels. Their appeals go to Medicare Provider Appeals, PO Box 14835, Lexington, KY 40512.

If you’re not contracted, a denial goes straight to appeal, and you have 65 days. Send it to PO Box 14067, Lexington, KY 40512.

Aetna’s guide for out of network providers adds a condition: a signed Waiver of Liability, saying you “will not bill the enrollee regardless of the outcome of the appeal.” Aetna dismisses the appeal if the signed waiver hasn’t arrived 60 calendar days after the appeal did.

A disagreement over the amount, not the denial, isn’t an appeal. The same guide sends disputes over “the amount you can collect if the beneficiary were in Original Medicare” to Aetna’s payment dispute process.

Aetna Better Health: each state sets its own

Aetna Better Health is Aetna’s Medicaid business, and each state plan publishes its own claim rules. Here are three, from their claims pages:

All three count an inpatient claim from the discharge date, and all three allow for a contractual exception.

Illinois’s page also gives “180 days from the paid date to resubmit a revised version of a processed claim.” When two clocks could apply, go by the one that ends first.

Disputes vary just as much. Illinois wants a reconsideration “within 90 calendar days of the original determination.” Louisiana allows 180 days from the remittance advice paid date, then 90 calendar days for a second level appeal.

These plans have their own payer IDs, too. Kentucky’s is 128KY. Check the card and the plan’s claims page before you send anything.

Aetna Signature Administrators cards

Some cards show the Aetna logo next to another company’s, with a reference to Aetna Signature Administrators. On those plans, an outside administrator handles the claims. Aetna’s guide is direct: “Please send all claims electronically to the payer ID listed on the member’s ID card.” And: “Please don’t send claims to us.”

The administrator processes and pays the claim, so ask it for the filing limit. The UMR guide shows how an administrator’s rules play out.

Before you file

• Read the card first. Aetna commercial, Aetna Medicare, Aetna Better Health and Aetna Signature Administrators cards each send the claim somewhere different.
• Get your in network limit in writing. Until you have it, work to 90 days.
• Correct inside the filing limit. After it, ask about a reconsideration.
• Put the appeal date on the calendar the day a reconsideration comes back. You get 60 days, not 180.
• Submit what you start in Availity. A dispute left in Initiated status never reaches Aetna.
• Keep the 277CA for every claim. It’s the record that wins a CO-29 on a claim that was on time.

Comparing payers? The Cigna, UnitedHealthcare and Optum behavioral health guides cover their rules the same way.

Sources

• Aetna, Provider Manual: Resources, Policies and Procedures, June 2026.
• Aetna, Provider Manual State Supplement, 2026.
• Aetna, Disputes and Appeals Overview.
• Aetna, Dispute and Appeal Process: State Exceptions to Filing Standard.
• Aetna, Provider Reference Guide, August 2026.
• Aetna, Our Denial Appeals Process for Out of Network Providers, Medicare, 2021.
• Aetna, Aetna Signature Administrators Solution, April 2026.
• Aetna, OfficeLink Updates, September 2021, copy published by the Maryland Department of Health.
• Aetna, OfficeLink Updates, December 2022.
• Texas Insurance Code, Section 1301.102.
• Aetna Better Health of Illinois, File or Submit a Claim.
• Aetna Better Health of Kentucky, File or Submit a Claim.
• Aetna Better Health of Louisiana, File or Submit a Claim.

Reference information only. Not billing advice. Filing limits change, and your contract, your state or the plan behind a card may set different ones. Confirm with Aetna or the plan’s administrator before you rely on a date.