AmeriHealth Caritas Florida Timely Filing Limit

The most important thing to confirm with AmeriHealth Caritas Florida is not just the number of days, but also what event starts the clock. Some payer documents measure from date of service, some from discharge, and some publish different rules for corrected claims or appeals.

At a glance

• AmeriHealth Caritas Florida generally requires contracted providers to submit claims within the time frame allowed by their contract, generally 180 days from the date of service. Non-contracted providers have a 12-month filing limit from the date of service/discharge or from when the provider receives the enrollee’s correct name and address. The provider manual also distinguishes primary vs secondary payer claim timeliness and corrected-claim timing.

Initial claim filing limits

• Contracted providers: generally 180 days from the date of service, unless the contract specifies otherwise.
• Non-contracted providers: within 12 months of the date of service or discharge from inpatient setting, or the date the provider was furnished the enrollee's correct name and address.
• Provider manual summary indicates: primary payer initial claim submission timeframe 6 months*; secondary payer initial claim submission timeframe 90 days* (timeframes begin on the relevant trigger date).

Corrected claim filing limits

• Provider manual summary indicates corrected claims for primary payer: 6 months* from date of discharge (inpatient) or date of service (outpatient).
• Provider manual summary indicates corrected claims for secondary payer: 90 days* from the primary payer’s final determination.
• A March 2024 provider alert temporarily extended timely filing for claims impacted by the Change Healthcare disruption.

Appeal and reconsideration deadlines

• No general claim appeal deadline was located in the searched provider-facing materials.
• A January 2025 provider alert states disputes received outside the plan’s timely filing requirements will not be reviewed.

Trigger basis and caveats

• Claims are considered received on the date AmeriHealth Caritas Florida receives them.
• Different triggers apply depending on whether AmeriHealth Caritas Florida is primary or secondary payer, and whether the submission is initial or corrected.
• Some network disruption notices created temporary filing extensions for claims affected by the Change Healthcare incident.
• The 6-month and 90-day figures appear in a provider-manual summary and may be contract- or line-specific; the claims protocols page separately states the general contracted-provider rule as 180 days from date of service.
• Use the more specific contract or line-of-business instructions where applicable.
• Operational exceptions tied to the 2024 Change Healthcare disruption are historical and should not be treated as current general rules.

Provider resources

• Providers homepage (official)
• Prior Authorization (official)
• Prior Authorization Lookup Tool (official)
• Claims Submission Process (official)
• Claims Submission Protocols (official)
• Provider Manual (PDF) (official)
• Behavioral Health Prior Authorization Requirements (official)
• Pharmacy Prior Authorization (official)

Sources