SilverSummit Health Plan (Ambetter) Timely Filing Limit

The most important thing to confirm with SilverSummit Health Plan (Ambetter) 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 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