The Buckeye timely filing limit is 365 days for most plans. So for office visits, outpatient care, and other professional claims, the clock starts on the date of service. For inpatient hospital claims, however, it starts on the discharge date instead.
Here is a simple example. A patient is admitted on January 1 and discharged on January 10. In that case, the filing period begins on January 10, not on the admission date. For a routine office visit, it begins on the day of the visit. Either way, Buckeye must receive the claim within that window.
One thing is important to know up front, though. The 365-day limit applies to Buckeye’s Medicaid, Medicare (Wellcare by Buckeye), and MyCare Ohio plans. Ambetter from Buckeye, the Marketplace plan, is different. It gives you only 180 days from the date of service. On top of that, corrected claims, secondary claims, and appeals each run on their own clock. The sections below walk through each one.
Buckeye Timely Filing Limit at a Glance (2026 Updated)
Use this table as a quick reference. After that, read the matching section for the details and exceptions.
| Claim action | Buckeye Medicaid / Medicare / MyCare | Ambetter (Marketplace) |
| Original claim submission | 365 days from the date of service (or discharge for inpatient) | 180 days from the date of service |
| Corrected claim / adjustment | 180 days from the EOP date | 180 days from the EOP date |
| Coordination of benefits (secondary) | 180 days from the primary payer’s EOP | 180 days from the primary payer’s EOP |
| Claim payment dispute (Medicaid) | 12 months from the date of service or 60 days from the EOP, whichever is later | 180 days from the EOP date |
| Clinical / medical-necessity appeal | 180 days from the Notice of Action | 180 days from the EOP / notice |
These are the windows Buckeye has published at the time of writing. Rules can change, so always confirm the current figure in Buckeye’s provider manual or contact BellMedEx at (888) 987-6250 before you rely on it for a specific claim.
Buckeye Timely Filing Limit for Secondary Claims (COB)
Secondary claims do not simply inherit the 365-day window. When Buckeye is the secondary payer, you must submit the claim within 180 days of the primary payer’s EOP or EOB date. This is a separate and shorter clock, and it is easy to miss.
For example: the primary insurer issues its EOB on March 1. From that date, you have about 180 days, so until roughly the end of August, to file the secondary claim with Buckeye. If the primary payer takes months to process the claim, that delay eats into your window. For this reason, submit the secondary claim as soon as the primary EOB arrives.
Here are a few things to keep in mind when you bill secondary claims:
- Use EDI when you can. Electronic filing lets you skip paper secondary claims in most cases. In addition, it gives you proof that the claim was received.
- Get the COB details right. Claims get denied when the other insurance details are missing or wrong. So verify and update coordination of benefits information whenever a patient has extra coverage.
- Watch the timing. The 180-day clock runs from the primary EOP, not from the day you get around to billing. Do not wait on a slow primary payer.
| Factor | Buckeye requirement (secondary / COB claims) |
| Filing limit | 180 days from the primary payer’s EOP/EOB date |
| Relationship to the 365-day rule | A separate, shorter deadline. The COB window governs, not the original 365 days. |
| Clock starts | Date of the primary payer’s EOP/EOB |
| Common denial cause | Missing or incorrect other-insurance (COB) information |
Buckeye Timely Filing Limit for Corrected Claims
The timely filing limit for Buckeye corrected claims runs on a different clock than the original claim. First, a quick definition. A corrected claim is one you resubmit to fix an error on the original, such as a wrong diagnosis code, a missing modifier, or the wrong number of units.
Corrected claims and adjustments are due within 180 days of the EOP date on the original claim. Correcting a claim does not start a new 365-day period. In other words, you do not get a fresh year. So send corrections as soon as you spot the error.
Here is what you need to know when you submit a corrected claim:
- Mark it clearly. Whether you file electronically or on paper, mark the claim as a corrected claim or a resubmission. On paper, include the original claim number, the EOP, and a short note on what changed. On EDI, use the right claim frequency code (7 for a replacement, 8 for a void).
- Know when to use it. Common reasons include fixing a billing error, correcting other insurance details, or following up on a claim that processed incorrectly.
- Include the required details. If the corrected claim is missing the original claim number or the EOP, Buckeye may deny it as a duplicate or reject it for processing.
Keep in mind that a corrected claim is new billing. A dispute or appeal is different, because there you ask Buckeye to change its decision. The two follow different rules and deadlines, which the next section covers.
Buckeye Timely Filing Limit for Disputes and Appeals
Disputes and appeals run on their own clocks. The deadline depends on the plan and on the type of review. The key difference is between a claim payment dispute and a clinical appeal. In a payment dispute, you disagree with how a claim was paid or denied. In a clinical appeal, on the other hand, the denial was based on medical necessity or level of care.
| Dispute / appeal type | Filing deadline | Typical reasons |
| Medicaid claim dispute (DOS on/after Feb 1, 2023) | 12 months from the date of service or 60 days from the EOP, whichever is later | Payment errors, timely filing reconsiderations, most claim disagreements (including medical necessity review) |
| Clinical / medical-management appeal | 180 days from the Notice of Action | Denial, reduction, suspension, or termination of authorized services |
| Ambetter and Medicare (Wellcare) claim disputes | Generally 180 days from the EOP | Payment and coding disputes, benefit limits, eligibility issues |
| Medicare non-contracted provider payment appeal | 65 days from the EOP (with a signed Waiver of Liability) | A non-par provider disagrees with a Medicare Advantage payment or denial |
Once Buckeye receives a dispute or appeal, it follows set review timelines. These vary by plan and by review type. As a general guide:
- Claim disputes (Medicaid): Buckeye reprocesses and pays or upholds the claim within about 30 days of its written notice of resolution.
- Standard clinical appeals: Buckeye acknowledges within a few business days. After that, it resolves standard reviews within 15 calendar days, with up to 14 extra days if it needs more information.
- Expedited clinical appeals: For urgent cases that could affect a member’s health, Buckeye issues a decision within about 72 hours.
Exact timeframes differ by plan. Therefore, confirm them in the manual that applies to your claim (Medicaid, Ambetter, or Wellcare Medicare).
Buckeye Medicaid Timely Filing Limit
For Buckeye Medicaid, you must submit the original claim within 365 days of the date of service. This matches the federal Medicaid standard (42 CFR § 447.45), which allows up to 12 months for claim submission.
| Claim action | Deadline |
| Original claim submission | 365 days from the date of service |
| Corrected claim / adjustment | 180 days from the date of the EOP |
| Coordination of benefits (secondary) | 180 days from the primary payer’s EOP |
| Claim dispute / appeal | 12 months from the date of service or 60 days from the EOP, whichever is later |
Key point: the original claim clock does not restart for corrections, secondary billing, or resubmissions. In fact, each of those has its own shorter deadline.
Buckeye Medicare Timely Filing Limit (2026 Changes)
The Buckeye Medicare timely filing limit is still 365 days from the date of service. The plans themselves changed for 2026, though, so check the plan and member ID before you bill. Buckeye now offers its Medicare Advantage and dual plans under the Wellcare by Buckeye Health Plan brand.
The old MyCare Ohio Medicare-Medicaid Plan has ended. As a result, those members moved to a new dual plan called Wellcare Buckeye MyCare Ohio Dual Align (HMO D-SNP) on January 1, 2026. For dates of service on or after that date, bill the new plan with the member’s updated ID. Otherwise, claims billed under an old MyCare ID may be rejected.
Here are the timely filing rules for the Medicare products:
| Plan / action | Timely filing | Key rule |
| Wellcare by Buckeye Medicare Advantage / D-SNP | 365 days from the date of service | Use the current 2026 plan and member ID |
| Former MyCare (dates of service before 2026) | 365 days from the date of service | Bill under the plan in effect on the date of service |
| Corrected claims / adjustments | 180 days from the EOP date | Mark clearly as corrected and include the original claim number |
| Non-par provider payment appeal | 65 days from the EOP | Include a signed Waiver of Liability |
A few general reminders for 2026 Medicare claims:
- Verify the plan and ID. Use each member’s updated 2026 member ID. Also confirm the plan type (HMO-POS, HMO-POS D-SNP, or the MyCare HMO D-SNP) before you bill.
- Use the Wellcare manual. Billing and appeal guidance for the Medicare plans now lives in the Wellcare provider manual on Buckeye’s provider resources page.
You may also see mentions of specific 2026 Medicare processing changes, such as new pre-payment edits or a short-term EDI issue. Notices like these are time-limited. So verify them against a current Buckeye provider bulletin before you rely on them.
Is the Buckeye Timely Filing Limit Different by State?
Many providers search for the Buckeye timely filing limit by state. Some look it up as the timely filing limit of Buckeye, and others as the timely filing limit for Buckeye in a particular state. Either way, the answer is the same. Buckeye Health Plan, also known as Buckeye Community Health Plan, operates only in Ohio. It is an Ohio managed care organization under contract with the Ohio Department of Medicaid, and it also offers Ambetter Marketplace and Wellcare Medicare plans in the state.
Because Buckeye is an Ohio-only payer, its filing rules do not change from state to state. Instead, the same Ohio guidelines apply across all 88 counties, no matter the plan type.
| Plan | State | Original claim timely filing limit |
| Buckeye Medicaid | Ohio | 365 days from the date of service |
| Wellcare by Buckeye MyCare / D-SNP (dual) | Ohio | 365 days from the date of service |
| Wellcare by Buckeye Medicare Advantage | Ohio | 365 days from the date of service |
| Ambetter from Buckeye (Marketplace) | Ohio | 180 days from the date of service |
As a reminder, the other deadlines still apply. Corrected claims and adjustments are due 180 days from the EOP. COB claims are due 180 days from the primary EOP. Medicaid disputes are due 12 months from the date of service or 60 days from the EOP, whichever is later.
Note: Buckeye Health Plan is not the same as Northern Buckeye Health Plan. The latter is a separate, unrelated employer health group in northwest Ohio. Always confirm the payer ID before you submit, or your claim may go to the wrong payer.
Common Billing Errors That Affect Timely Filing
Small billing mistakes can get a claim rejected or returned. After that, you must correct and resubmit while the clock keeps running. So the best way to protect your window is to get the claim right the first time. The most common errors include:
- Using outdated CPT or HCPCS codes for the date of service
- Missing the required 4th or 5th digit on ICD-10 codes
- Entering a wrong provider number, NPI, or Tax ID
- Leaving out or mistyping the member’s Medicaid ID
- Listing wrong or unverified other-insurance (COB) details
- Sending handwritten, photocopied, or faxed claims when only original, typed claims are accepted
- Printing with poor alignment, which pushes data outside the form fields
A late rejection can leave you little time to refile. For that reason, accuracy on the first submission is critical to meeting the timely filing window.
How to Submit Provider Claims to Buckeye
How you submit a claim matters. Your submission method is also your proof that you filed on time. So if the payer ever questions timely filing, that proof settles the matter. Here are the main ways to file provider claims within the window.
Electronic Claims (EDI)
Buckeye recommends electronic claims in the EDI 837 Professional or 837 Institutional format. The big benefit is the confirmation you get back (a 999/277CA report). It shows when the claim was sent and accepted. As a result, it serves as proof of timely filing if a dispute ever comes up.
For Ambetter and Medicare (Wellcare by Buckeye) claims, you can file through a clearinghouse with payer ID 68069. Medicaid works a little differently. Ohio’s Next Generation program routes electronic Medicaid claims through the state’s central EDI system first, and only then do they reach Buckeye. For that reason, Medicaid trading-partner setup goes through the Ohio Department of Medicaid, not through a Buckeye clearinghouse ID. To be safe, confirm the payer ID and routing with your clearinghouse for each plan.
Also, every claim must include your NPI and Tax ID. If either one is missing, the claim will be rejected. A rejected claim does not count as a timely submission until you fix the error and resubmit it successfully.
Paper Claims
Some claims must go on paper. Professional claims use the CMS-1500 form (formerly HCFA-1500), while facility claims use the CMS-1450/UB-04 form (formerly UB-92). In addition, a few services must always be mailed on paper with the required federal consent forms attached. These include sterilization, hysterectomy, and abortion claims.
Where you mail a paper claim depends on the plan and the service:
- Medicaid medical claims: Buckeye Health Plan, P.O. Box 6200, Farmington, MO 63640-3800
- Behavioral health claims: Buckeye Health Plan, P.O. Box 6150, Farmington, MO 63640-3800
- Ambetter (Marketplace) claims: Ambetter from Buckeye, P.O. Box 5010, Farmington, MO 63640-5010
- Dental and vision claims: Separate vendors handle these benefits (for example, Envolve Dental handles dental). Their claim addresses change from time to time, so confirm the current address in Buckeye’s provider manual before you mail anything.
Paper claims do not come with an automatic receipt the way EDI claims do. Therefore, keep proof that you mailed the claim, such as a certified mail receipt or a tracking record. You will need it if timely filing is ever questioned.
FAQs
Does the 365-day clock restart if my claim is rejected?
No, it does not. A rejected claim never resets the clock. You still have to correct and resubmit within the original window. That is why a rejection late in the year is risky.
What if the patient has other insurance?
Bill the primary insurer first. After that, submit the secondary claim to Buckeye within 180 days of the primary payer’s EOP. Do not rely on the original 365 days in that case.
How do I prove I filed on time?
Keep your EDI acceptance report (the 999/277CA) for electronic claims. For paper claims, keep a certified mail or tracking receipt. In a timely filing dispute, that record is what settles things in your favor.
How long do I have to appeal a timely filing denial (Medicaid)?
You can file a claim dispute up to 12 months from the date of service or 60 days from the EOP, whichever is later. Along with it, attach proof of your original, timely submission.
Conclusion
The Buckeye timely filing limit of 365 days is more generous than most payers offer. Even so, it is strict, and claims are denied once the deadline passes. Also, remember that the 365 days cover only the original claim. Corrected claims are due 180 days from the EOP, secondary claims 180 days from the primary EOP, and Buckeye Medicaid disputes within 12 months of the date of service or 60 days from the EOP.
In practice, most filing problems do not come from the 365-day rule itself. Instead, they happen when a rejected claim is not fixed in time, when provider details like the Tax ID are wrong, or when a resubmission is not marked correctly. So file electronically when you can, fix errors fast, mark corrections clearly, and keep records of every submission. If you stay organized, the deadlines are easy to manage.
