Sendero Health Plans, Timely Filing Limit

Sendero Health Plans,'s first published filing rule in the reviewed sources is: Professional claims: 95 days from date of service.. Confirm the plan, provider agreement, and event that starts the filing period before submission.

At a glance

• Sendero’s provider manual sets different timely-filing windows by claim type and by whether the claim is initial or corrected. For most initial claims, the window is 95 days from the relevant date; corrected claims generally have a 120-day window from the relevant date. The manual also sets a separate 95-day rule for COB claims from the other payer’s Explanation of Payment.

Initial claim filing limits

• Professional claims: 95 days from date of service.
• Ancillary services: 95 days from date of service.
• Monthly-billed ancillary services (e.g., home health or rehabilitation therapy): 95 days from the last day of the month billed.
• Outpatient hospital services: 95 days from date of service.
• Inpatient hospital services: 95 days from date of discharge.
• COB claims: 95 days from the date of the other payer’s Explanation of Payment.

Corrected claim filing limits

• Professional corrected claims: 120 days from date of service.
• Ancillary corrected claims: 120 days from date of service.
• Monthly-billed ancillary corrected claims: 120 days from the last day of the month billed.
• Outpatient hospital corrected claims: 120 days from date of service.
• Inpatient hospital corrected claims: 120 days from date of discharge.

Appeal and reconsideration deadlines

• Level I Appeal Reconsideration must be filed in writing within 120 calendar days of the initial decision (EOP or medical necessity determination).

Trigger basis and caveats

• For initial claims, the deadline is tied to date of service, date of discharge, or last day of the month billed depending on claim type.
• For COB claims, the deadline is tied to the other payer’s Explanation of Payment.
• For appeals, the deadline is tied to the initial decision date (EOP or medical necessity determination).
• The provider manual reviewed is rev. 11-26-24; older manuals show different timely-filing language, so use the current manual and any plan-specific notices for the applicable date of service.
• The manual says exceptions are limited and do not include neglect, indifference, or lack of diligence.
• Some claim-type rules may vary by billing format and line of business.

Provider resources

• Provider Portal Login (official)
• Provider Resources / Provider page (official)
• Provider Manual (rev. 11-26-24) (official)
• Provider Portal User Guide (official)
• Prior Authorization Process Description (official)
• Claim Reconsideration/Appeal Request Form (official)
• Preauthorization Code Interactive Lookup Tool (official)

Sources