SHA, LLC (FirstCare) Timely Filing Limit

The most important thing to confirm with SHA, LLC (FirstCare) 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

• FirstCare’s cited filing limits vary by line of business. Commercial HMO/PPO provider manual states claims must be filed within 95 days from date of service; STAR/CHIP manual also states 95 days from date of service is the maximum allowable time absent extenuating circumstances. Redetermination/appeal windows vary by product and claim type.

Initial claim filing limits

• Commercial HMO/PPO: 95 days from date of service
• STAR/CHIP: 95 days from date of service absent extenuating circumstances

Corrected claim filing limits

• Commercial HMO/PPO: corrected billing/late charges should be treated as an appeal to the original claim rather than a new claim
• Medicaid: redeterminations must be submitted within 120 days from original claim adjudication/determination, and corrected claims are not to be filed on the redetermination form

Appeal and reconsideration deadlines

• Commercial HMO/PPO claim appeals: within 90 days from initial date of payment/EOP
• Medicaid redeterminations: within 120 days from original claim adjudication/determination
• STAR/CHIP member appeal deadlines are separate member-benefit rules and are not provider claim filing deadlines

Trigger basis and caveats

• The cited commercial claim appeal clock starts from the initial payment/EOP date.
• The cited commercial filing limit for past filing deadline appeals references the date of service and the need to check claim status after 45 days.
• Medicaid redetermination timing is tied to original determination/adjudication date.
• Some claim denials based on past filing deadlines may be appealed with supporting proof such as timely-filing evidence.
• Deadlines vary by product and by whether the action is a claim appeal, redetermination, corrected claim, or member appeal.
• The cited sources do not provide one single universal deadline for every FirstCare product line.
• Where the manual says 'claims should be submitted within the time limits noted in the Provider Agreement,' the provider agreement may control if different.

Provider resources

• FirstCare Provider information hub (official)
• STAR & CHIP Provider Information (official)
• Provider Authorization Information (official)
• 24/7 Self-Service Portal (official)
• Commercial HMO/PPO Provider Manual (PDF) (official)
• 2025 STAR and CHIP Provider Manual (PDF) (official)
• Medicaid corrected claims/redeterminations instructions (PDF) (official)
• Provider Portal registration (official)

Sources