Superior HealthPlan Timely Filing Limit

The most important thing to confirm with Superior HealthPlan 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 Medicaid/CHIP claims, Superior’s manual states outpatient claims must be received within 95 days of each date of service, inpatient hospital claims within 95 days of discharge, and nursing facility room-and-board claims within 365 days of date of service. Rejected/unclean claims do not satisfy timely filing requirements. For claims appeals and requests for reconsideration, the Medicaid manual says they must be received within 120 days from the most recent adjudication date. For corrected claims, the Medicaid and STAR+PLUS MMP manuals state they must be submitted within 120 days of the most recent adjudicated date / initial claim disposition. Superior’s 2025 notice says claim filing guidelines are strictly enforced. Some older or plan-specific materials reference different wording, so provider contract and line-of-business rules should be checked before filing.

Initial claim filing limits

• Medicaid/CHIP outpatient claims: 95 days from each date of service
• Medicaid/CHIP inpatient hospital claims: 95 days from date of discharge
• Medicaid/CHIP nursing facility room-and-board claims: 365 days from date of service
• Rejected/unclean claims do not count toward timely filing

Corrected claim filing limits

• Medicaid: corrected claims must be sent within 120 days of the most recent adjudicated date of the claim
• STAR+PLUS MMP: corrected claims must be sent within 120 days of the initial claim disposition

Appeal and reconsideration deadlines

• Medicaid: all claim appeals and requests for reconsideration must be received within 120 days from the most recent adjudication date of the claim
• Medicaid manual also states claim appeals regarding the amount reimbursed or a denial for a service must be submitted within 120 days from the date of the last denial and/or adjustment to the original claim
• Medicaid manual states all claim appeals must be finalized within 24 months from date of service

Trigger basis and caveats

• The filing clock is measured from date of service for outpatient claims, date of discharge for inpatient claims, and date of service for nursing facility claims.
• For appeals/reconsiderations, the trigger is the most recent adjudication date or last denial/adjustment date depending on the claim process language used in the manual.
• For corrected claims, the trigger is the most recent adjudicated date / initial claim disposition, not the original submission date.
• Rules vary by product/manual; the Medicaid manual, STAR+PLUS MMP manual, and possibly other line-specific materials should be used for the applicable product.
• A rejected claim letter is not proof of timely filing.
• The claim appeal and corrected claim requirements are contract- and plan-specific and should be verified against the relevant provider manual and provider contract.

Provider resources

• Provider login / secure portal (official)
• Prior authorization overview and fax/phone/portal directory (official)
• Billing and coding / electronic transactions (official)
• Provider forms (official)
• Medicaid provider manual PDF (official)
• STAR+PLUS MMP provider manual PDF (official)
• Corrected claim form (official)

Sources