Tufts Health Plan
Tufts Health Plan Timely Filing Limit
The currently linked 2025 commercial claims chapter states 90 days from service for professional and outpatient claims and 90 days from discharge for…
Short answer
The currently linked 2025 commercial claims chapter states 90 days from service for professional and outpatient claims and 90 days from discharge for inpatient claims. COB claims are due within 90 days of the primary payer explanation of payment.
Coverage: Tufts Health Plan commercial HMO, EPO, POS, and PPO manual. Do not transfer these rules to public plans, senior products, or Harvard Pilgrim.
Tufts Health Plan filing guidance from the reviewed sources: Commercial professional and outpatient: 90 days from date of service. Confirm the plan, provider agreement, and event that starts the filing period before submission.
At a glance
- The currently linked 2025 commercial claims chapter states 90 days from service for professional and outpatient claims and 90 days from discharge for inpatient claims. COB claims are due within 90 days of the primary payer explanation of payment.
Initial claim filing limits
- Commercial professional and outpatient: 90 days from date of service.
- Commercial inpatient: 90 days from discharge.
- Commercial COB: 90 days from the primary payer explanation of payment; include the primary EOP.
Corrected claim filing limits
- Not clearly published in the researched sources.
Appeal and reconsideration deadlines
- Commercial timely filing denial disputes: 90 days from the original denial explanation of payment.
Trigger basis and caveats
- Rejected claims must be accepted within the original deadline; rejection does not create a fresh filing period.
Provider resources
- Authorization guidance (official)
- Filing guidance (official)
- Claims guidance (official)
Sources
| Fact | Value | Source | Confidence |
|---|---|---|---|
| Official provider guidance | The currently linked 2025 commercial claims chapter states 90 days from service for professional and outpatient claims and 90 days from discharge for inpatient claims. COB claims are due within 90 days of the primary payer explanation of payment. | Official | high |
Update notes
Last updated: 2026-10-30.
- Added the currently linked commercial manual and Point32Health authorization guidance. The located claims chapter is dated 2025.
- Preserved separate service, discharge, and primary-EOP triggers. Public-plan and senior-plan rules are outside this record scope.
Last reviewed: October 30, 2026
Sources used: 1 official
Reduce manual workflow follow-up
See how Clark Street Health coordinates patient operations, staff exceptions, and follow-up without replacing payer rules or practice controls.
Review healthcare workflow automation