EmblemHealth Timely Filing Limit

Coverage: EmblemHealth New York medical claims; participating, nonparticipating, self-funded and delegated benefit rules differ.

EmblemHealth filing guidance from the reviewed sources: Participating medical/facility/hospital claims: 120 days from service or issuance of the primary payer’s EOB, subject to agreement and listed exceptions. Confirm the plan, provider agreement, and event that starts the filing period before submission.

At a glance

• Participating medical, facility and hospital filing is generally 120 days, subject to the applicable agreement and product exceptions.

Initial claim filing limits

• Participating medical/facility/hospital claims: 120 days from service or issuance of the primary payer’s EOB, subject to agreement and listed exceptions.

Corrected claim filing limits

• Not clearly published in the researched sources.

Appeal and reconsideration deadlines

• Not clearly published in the researched sources.

Trigger basis and caveats

• Do not apply this participating rule to nonparticipating commercial, Medicaid/Child Health Plus or Medicare claims. Self-funded groups may have different limits.
• Behavioral health handled by Carelon and dental benefits require separate instructions. Corrected claim and appeal deadlines were not independently established.

Provider resources

• Official policy source (official)
• Official policy source (official)
• Official policy source (official)

Sources

Update notes

Last updated: 2026-10-30.

• Verified the authorization list, delegated-contact directory, filing page and electronic claims guide. Preserved participating and self-funded limitations.
• The signed agreement, member product and delegated benefit administrator remain necessary for final routing and deadlines.