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When to file
Filing a claim as soon as possible is the best way to facilitate prompt payment, but if you cannot, here's what you need to know:
Timely Filing Policy
(This policy applies to claims submitted directly to CIGNA HealthCare, and not to another entity.)
It's best to submit claims as soon as possible. If you're unable to file a claim right away, CIGNA HealthCare will consider:
- participating provider claims submitted six (6) months [180 days] after the date of service;
OR
- non-participating provider or member claims submitted one year [365 days] after the date of service.
If services are rendered on consecutive days, such as for a hospital confinement, the limit will be counted from the last date of service.
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Exceptions to timely filing limits:
- subject to applicable law;
- provider agreement specifically allows for additional time;
- coordination of benefits: The filing limit is applied based on the primary carrier's processing date stated on the explanation of benefit (EOB).
- Medicare (CIGNA HealthCare for Seniors): In accordance with Medicare processing rules, non-participating providers have from 15-27 months to file a new claim. Medicare members' claims must be filed no later than the end of the calendar year following the year in which the services were provided. However, the filing limit is extended another full year if the service was provided during the last three months of the calendar year.
| Date of Service | | Last Filing Date |
| 10/01/2001 - 9/30/2002 | | 12/31/2003 |
| 10/01/2002 - 9/30/2003 | | 12/31/2004 |
| 10/01/2003 - 9/30/2004 | | 12/31/2005 |
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- Medicare: The filing limit is applied based on the primary carrier's processing date stated on the explanation of benefit (EOB).
- Medicare Secondary Payer (MSP): A three-year (3) filing limitation applies.
- Medicaid: A two-year (2) filing limitation applies.
- resubmission of a claim in response to a request for information by CIGNA HealthCare. If a resubmission is not a CIGNA HealthCare request, and is not being submitted as an appeal, the filing limit will apply.
Extenuating circumstances:
- CIGNA HealthCare may request appropriate evidence of extraordinary circumstances that resulted in the delayed submission.
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Appeals for timely filing
We encourage you to submit your bills as soon as possible to facilitate prompt payment. As always, you can appeal denied claims if you feel an appeal is warranted. Remember: Your contract with CIGNA HealthCare prohibits member balance billing if claims are denied because they were not submitted within the timeframe outlined above.
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