Molina Healthcare of Texas, Timely Filing Limit

The most important thing to confirm with Molina Healthcare of Texas, 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

• For Texas Medicaid/CHIP/MMP claims in the provider manual, Molina states that non-electronic claims must be submitted within 95 days of date of service, and electronic claims must also be submitted within 95 days of date of service. For inpatient services, claims must be submitted within 95 calendar days after discharge; for outpatient services, within 95 calendar days after date of service. If Molina is not primary payer, claims must be submitted within 95 calendar days after final determination by the primary payer. The reviewed sources did not surface a separate Texas corrected-claim filing limit distinct from the timely filing rule.

Initial claim filing limits

• 95 days from date of service for non-electronic claims (Texas Medicaid/CHIP/MMP).
• 95 days from date of service for electronic claims (Texas Medicaid/CHIP).
• 95 calendar days after discharge for inpatient services.
• 95 calendar days after date of service for outpatient services.
• 95 calendar days after final determination by the primary payer when Molina is secondary.

Corrected claim filing limits

• Corrected claims are treated as new claims for processing purposes.
• The reviewed sources did not identify a separate corrected-claim filing window in Texas beyond the general timely filing rules.

Appeal and reconsideration deadlines

• Provider claim appeal deadlines were not clearly stated in the reviewed Texas provider sources.
• Member appeal deadlines are present in the manual, but those are not provider claim filing deadlines.

Trigger basis and caveats

• Date of service is the trigger for outpatient and electronic/non-electronic timely filing rules.
• Date of discharge is the trigger for inpatient claims.
• When Molina is not primary payer, the trigger is final determination by the primary payer.
• A 95-day rule appears in multiple Texas provider-manual sections; provider operations should verify the applicable line of business and claim type.
• Nursing facility and EVV references in the manual may have additional program-specific filing rules.
• No universal provider-appeal deadline for claim denials was confirmed from the reviewed sources.

Provider resources

• Texas Provider Home (official)
• Texas Provider Manual Home (official)
• Texas Provider Manual PDF (official)
• Texas Provider Contact Information (official)
• Texas Provider Portal / Availity Essentials entry (official)

Sources