Filing Deadline

Filing Deadline Policy

Tufts Health Plan follows the guidelines described in the Tufts Health Plan Claims Submission Policy. For professional or outpatient services, Tufts Health Plan must receive claims within 60 days from the date of service for Tufts Medicare Preferred HMO claims. For inpatient or institutional services, Tufts Health Plan must receive claims within 60 days from the date of hospital discharge. When a member has multiple insurance plans, the filing deadline for claims submission is 60 days from the date of the primary insurer’s explanation of benefits (EOB).



Filing Deadline Adjustments

To be considered for review, requests for review and adjustment for a claim received over the filing deadline must be submitted within 90 days of the SOA date on which the claim originally denied. Disputes received after 90 days will not be considered.

If the initial claim submission is after the filing deadline and the circumstances for the late submission are beyond the provider’s control, the provider may submit a payment dispute for reconsideration by sending a letter documenting the reason(s) why the claim could not be submitted within the contracted filing deadline and any supporting documentation.

Documented proof of timely submission must be submitted with any request for review and payment of a claim previously denied due to the filing deadline. A completed Provider Request for Claim Review Form must also be sent with the request.


For paper claim submissions, the following are considered acceptable proof of timely submission:

** Copy of patient ledger that shows the date the claim was submitted to Tufts Health Plan.

** Copy of EOB from the primary insurer that shows timely submission from the date that carrier processed the claim.

** Copy of EOB as proof that the member or another carrier had been billed, if the member did not identify him/herself as a Tufts Medicare Preferred HMO member at the time of service.

For EDI claim submissions, the following are considered acceptable proof of timely submission:

** For claims submitted though a clearinghouse or MD On-Line, a copy of the transmission report and rejection report showing that the claim did not reject at the clearinghouse or at Tufts Health Plan (two separate reports).

** For claims submitted directly to Tufts Health Plan, the corresponding report showing that the claim did not reject at Tufts Health Plan

** Copy of EOB from the primary insurer that shows timely submission from the date that carrier processed the claim

** Copy of EOB as proof that the member or another carrier had been billed, if the member did not identify him/herself as a Tufts Medicare Preferred HMO member at the time of service



The following are not considered to be valid proof of timely submission:

** Copy of original claim form

** Copy of transmission report without matching rejection/error reports (EDI)

** Verbal requests


Requests for filing deadline adjustments for Tufts Medicare Preferred HMO claims should be sent to the following address:

Tufts Medicare Preferred HMO Provider Payment Disputes P.O. Box 9162 Watertown, MA 02471-9162