Timely Filing Rule Change Coming – What You Need to Know for 2026
When it comes to claims processing, we know that consistency matters. That’s why ClaimLinx regularly reviews its policies to ensure they match, not only the needs of our members and providers, but also the standards used across the health insurance industry.
Beginning January 1, 2026, ClaimLinx will implement a new timely filing rule for all claims. From this date, all claims of any type must be filed within one year of the claim’s date of service.
This change is part of our ongoing effort to stay aligned with major medical carriers. While every carrier has its own timeline for timely filing, most fall between 90 days and 12 months. Moving to a one-year standard ensures we remain consistent and in step with industry expectations. It also helps reduce delays, streamline processing, and make the claims experience smoother for everyone involved.
We know updates like this may raise questions, so we’ve put together answers to help you understand exactly what’s changing and how it affects you.
What is the new timely filing rule?
As of January 1, 2026, ClaimLinx will require that all claims be received within one year of the date of service. If a claim is received after this deadline, it will be denied for untimely filing.
Why is this change being made?
The one-year deadline matches industry best practices. Most major medical carriers already have a similar, or shorter, policy timeline. Aligning with these timeframes helps create consistency and predictability. It also encourages timely submission, which benefits both providers and members by speeding up payment and reducing the risk of lost or incomplete claims.
Does this apply to all types of claims?
Yes. This rule applies to medical, dental, vision, and drug claims. The one-year deadline will be calculated based on the date of service, not the date the claim was prepared or sent.
What happens if a claim is submitted late?
If a claim is received after the one-year filing window, it will be denied for untimely filing. This means payment will not be made, and the cost may become the member’s responsibility, depending on the plan’s terms.
Will there be any exceptions?
Exceptions will be rare and will only be considered in certain circumstances, such as when a member was unable to file due to medical incapacity or when a provider was delayed due to extraordinary circumstances. However, these cases must be documented and will be reviewed individually.
How can members and providers make sure they meet the deadline?
Here are a few tips:
- Submit claims as soon as possible after the incurred date. Don’t wait until the deadline is near.
- Email claims directly or using the portal whenever possible to speed up delivery.
- Confirm processing of the claim by checking the ClaimLinx member or provider portal.
- Keep copies of all submissions and correspondence in case documentation is needed later.
What should I do if I’m unsure about my claim’s status?
You can log into the ClaimLinx portal anytime to check your claims in real time. The portal is linked directly with our processing system, so claims are updated as soon as they are entered. You can see the date of service, benefit details, and payment details all in one place.
When does the new rule take effect?
The one-year timely filing rule will apply to any claims received after January 1, 2026. This would include claims with a date of service before the change. For example, if a claim has a date of service of June 10, 2025, a member will have until June 10, 2026 to submit this claim. Please be sure to submit any lingering claims before the deadline.
In Summary
This change is all about keeping our claims process efficient, consistent, and in line with the rest of the industry. Submitting claims promptly protects your benefits, prevents unnecessary denials, and ensures you get the service you expect from ClaimLinx.
If you have questions about this change or need help understanding how it applies to your plan, contact our member services team or visit the ClaimLinx portal for more resources.
We’re Here to Support You
Change is never one-size-fits-all, and we’re committed to making this transition as easy as possible. If you have questions about the update, need help logging into your portal, or want assistance reviewing a claim, our Member Services team is ready to help.
You can reach us at (800) 858-1772 or by email at claims@claimlinx.com.
Thank you for choosing ClaimLinx. We appreciate your continued trust in our team as we work to make your benefits experience clearer, faster, and more convenient.
If you have questions about this change or need help understanding how it applies to your plan, contact our member services team or visit the ClaimLinx portal for more resources.
