SilverSummit Health Plan (Ambetter)
SilverSummit Health Plan (Ambetter) Timely Filing Limit
For the Medicaid billing manual reviewed, initial claims and encounters must be received within 180 calendar days of date of service or date of eligibility.…
Short answer
For the Medicaid billing manual reviewed, initial claims and encounters must be received within 180 calendar days of date of service or date of eligibility. If SilverSummit is secondary payer, the limit is 365 calendar days. Requests for reconsideration,…
SilverSummit Health Plan (Ambetter)'s first published filing rule in the reviewed sources is: 180 calendar days from date of service or date of eligibility. Confirm the plan, provider agreement, and event that starts the filing period before submission.
At a glance
- For the Medicaid billing manual reviewed, initial claims and encounters must be received within 180 calendar days of date of service or date of eligibility. If SilverSummit is secondary payer, the limit is 365 calendar days. Requests for reconsideration, corrected claims, or claim disputes must be received within 60 calendar days from the Remittance Advice date of payment or denial.
Initial claim filing limits
- 180 calendar days from date of service or date of eligibility
- 365 calendar days from date of service or date of eligibility when SilverSummit is the secondary payer
Corrected claim filing limits
- 60 calendar days from the date of Remittance Advice (RA) for corrected claims
- 60 calendar days from the date of RA for claim reconsideration or dispute
Appeal and reconsideration deadlines
- 60 calendar days from the date of the Medicaid Remittance Advice for reconsideration or claim dispute
Trigger basis and caveats
- The manual uses date of service or date of eligibility for initial filing.
- For secondary payer situations, the filing window extends to 365 calendar days.
- For reconsideration/corrected claims/disputes, the trigger is the Remittance Advice date.
- The retrieved timely-filing rules came from the 2022 Provider Billing Manual; a newer manual exists on the provider manuals page and should be checked for currentness before operational use.
- Appeal rights and deadlines may differ by claim type or line of business; only the Medicaid billing manual language was confirmed here.
Provider resources
- Provider Resources landing page (official)
- Provider Manuals (official)
- Prior Authorization (official)
- Electronic Transactions (official)
- Provider Toolkit (official)
- Provider Portal login (official)
- Medicaid Pre-Auth tool (official)
- TurningPoint cardiac program notice (official)
Sources
| Fact | Value | Source | Confidence |
|---|---|---|---|
| Initial timely filing and secondary payer window | Claims and encounters must be submitted within 180 calendar days of date of service or eligibility; if SilverSummit is secondary payer, within 365 calendar days. | Official | high |
| Reconsideration/corrected/dispute deadline | All claim requests for reconsideration, corrected claims or claim disputes must be received within 60 calendar days from the RA date. | Official | high |
| Appeal/reconsideration form language | Claim requests for reconsideration or claim disputes must be received within 60 calendar days from the date of the Medicaid Remittance; appeals are for adverse decisions and require medical records or medical information. | Official | medium |
Last reviewed: March 27, 2026
Sources used: 1 official
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