How to Avoid Denied Claims and Lost Revenue

You provided excellent treatment. You submitted the claim. Then… it’s denied. Not because of coverage issues—but because you waited too long to file.

This is where timely filing laws come in.

Most dental insurance plans have a deadline for when a claim must be submitted after treatment is rendered. Miss that window—even by a day—and your claim can be denied automatically, leaving you (or the patient) without reimbursement.

Let’s break down how timely filing rules work in dentistry, why they’re critical, and how to stay compliant.

What Is Timely Filing?

Timely filing refers to the timeframe in which a dental claim must be submitted to the insurance company after the date of service. If you miss the deadline, the insurance company is no longer obligated to pay—even if the procedure was fully covered.

Common Timely Filing Deadlines

Each plan is different, but here are the most common timely filing limits in dental insurance:

Insurance TypeTypical Timely Filing LimitPPO Plans90 days to 1 year from date of serviceMedicaid DentalAs little as 90 days in some statesUnion/Employer PlansMay allow up to 18 months or 2 yearsMedicare Advantage DentalVaries—usually 6–12 months

Pro Tip: Always check the specific plan's provider manual or contact the payer directly for exact timeframes.

What Happens If You File Late?

If you submit a claim after the timely filing window:

• It’s likely to be automatically denied

• You cannot bill the patient unless your financial policy disclosed this possibility up front

• Appeals are rarely successful unless you have proof that the delay was the insurance company’s fault

Bottom line: Late filing = no payment

How to Stay Ahead of Timely Filing Limits

1. Submit Claims Daily—or at Least Weekly

Don’t let claims pile up for weeks at a time. Establish a routine where your team:

• Reviews and submits claims promptly

• Follows up on rejections or missing information immediately

Tip: Create a same-day claim submission goal for your admin team.

2. Track Unsubmitted Claims

Use your practice management software to run a “claims not submitted” or “open treatment with no claim” report regularly.

This catches:

• Claims that were never sent

• Procedures that were posted but not billed

• Claims stuck in draft mode or missing attachments

3. Confirm Eligibility and Plan Rules in Advance

Some patients change jobs or lose coverage without realizing it. Always verify:

• Coverage is active on the date of service

• You’re sending the claim to the correct payer

• The payer has a known timely filing window (document it if possible)

4. Appeal Strategically—But Don’t Rely on It

If you miss a deadline, you can attempt an appeal, but success is rare unless:

• The insurance company gave you incorrect instructions

• The claim was submitted on time but lost due to system error (and you have proof)

• There were extenuating circumstances (e.g., natural disaster, cyberattack, etc.)

Always include:

• The original date of service

• Explanation of the delay

• Copies of any correspondence or system-generated claim activity logs

5. Create a Timely Filing Cheat Sheet for Your Team

Document the most common plans your office participates with, and list:

• Their timely filing limits

• Appeal deadlines

• Where to find official policy info

Keep this as a quick reference for your admin team so they’re not scrambling or guessing.

Legal vs. Contractual Timely Filing

It's important to understand that “timely filing laws” can vary based on state insurance regulations, but most dental claims are subject to contractual timely filing policies set by the payer—not state or federal law.

That means:

• PPO plans typically follow what's written in your provider agreement

• Government-sponsored plans (like Medicaid) may be governed by state filing laws

If you’re unsure whether a denial was legal or just policy-driven, consult with a dental billing expert or healthcare attorney.

Final Thoughts: Timely Filing Is Preventable Lost Revenue

There’s nothing more frustrating than providing care and losing payment because a deadline slipped by. The good news? Timely filing errors are 100% preventable with the right systems in place.

By staying organized, educating your team, and tracking claims proactively, you protect your practice’s revenue—and avoid unnecessary financial stress down the road.

Benjamin Tuinei

Founder - Veritas Dental Resources, LLC
Phone: 888-808-4513

Services:
PPO Fee Negotiators | PPO Fee Negotiating | Insurance Fee Negotiating
Insurance Credentialing | Insurance Verifications

Websites:
www.VeritasDentalResources.com | www.VerusDental.com