29: The time limit for filing has expired
Denial Occurrence:
- This denial occurs when insurance receives the claim after TFL expired.
TFL:
- TFL stands for timely filing limit.
- A timely filing limit is a time frame set by an insurance company for providers to submit a claim.
- TFL must be calculated from the date of service (DOS).
POTF:
- POTF stands for Proof of timely filing.
- You can consider the below proofs as POTF,
- An initial filed claim to the same insurance which is not received by the payer.
- Initially rejected claims.
- Initial billing to any other payer.
AFL:
- AFL stands for appeal filing limit.
- ATL must be calculated from the date of denial (DOD).
On Call Scenario:
Claim denied as Past timely
filing or TFL expired
↓
May I get the denial date?
↓
When did you receive the claim?
↓
How much is the Timely filing limit?
↓
Check if the claim was received within TFL
↙ ↘
Yes No
↓ ↓
Could you please send the Check if POTF available
claim back for reprocessing ↙ ↘
since the claim was received Yes No
within TFL? ↓ ↓
↓ Can we appeal with POTF? May I have
Claim denied as Past timely
filing or TFL expired
↓
May I get the denial date?
↓
When did you receive the claim?
↓
How much is the Timely filing limit?
↓
Check if the claim was received within TFL
↙ ↘
Yes No
↓ ↓
Could you please send the Check if POTF available
claim back for reprocessing ↙ ↘
since the claim was received Yes No
within TFL? ↓ ↓
↓ Can we appeal with POTF? May I have
What is the TAT for reprocessing? ↓ the claim# &
↓ What is the fax# or Mailing call ref#?
May I have the claim# & address to send an appeal? &
↓ What is the fax# or Mailing call ref#?
May I have the claim# & address to send an appeal? &
call ref#? What is the appeal limit?
↓
May I have the claim# &
call ref#?
Important Notes & Actions:
- Please take action as per your process update. Below actions can be different from your process update.
- If the claim was denied incorrectly and the rep send the claim back for reprocessing then you can set the follow-up for the TAT provided by the rep.
- If the claim was billed after TFL expired and POTF is available that proves that we billed the claim within TFL then send an appeal to insurance.
- If the claim was billed after TFL expired and there is no POTF available then you can adjust the claim.
- You may come across a scenario where a claim was initially billed within TFL to different insurance and billed to current insurance after TFL expired then you can use initial billing information as POTF and send an appeal to insurance.
- Calculate the appeal filing limit, if it is not crossed then send the POTF, or else write off the claim if the appeal filing limit is crossed.
- Sometimes the client wants us to send POTF even if the AFL is crossed, so work accordingly.
- You may also come across a scenario where the claim was billed to insurance on the last date of the TFL period but the claim was received by insurance after the TFL expired (for example, TFL is 90 days and the claim was billed on 90th day to insurance but the claim was received by the insurance on 91st day or afterward). Then you can send an appeal on such claims with POTF to receive the payment.
- Click here to go to Quiz
Prepare Notes:
Source of Status:
Clearing House Comment (Please make the changes if required):
Insurance Name:
Clearing House Name:
Insurance Phone#:
Rep Name:
Website Name:
Denial Date:
Received Date:
TFL:
Is claim received within the TFL?:
TAT for Reprocessing:
Is POTF Available?:
Mode of appeal:
Fax Number:
Website Link:
Appeal Limit:
Mailing Address:
Additional Comment:
Claim Number:
Call Reference#
Action:
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Can you make a list of all insurances and TFL updated for 2022?
ReplyDeleteYes, we are working on it and will update the post soon.
Deletewhen you will update pls post asap
ReplyDeleteApologies for the delayed. The TFL sheet post has been added,
Deletehttps://www.arlearningonline.com/p/tfl-sheet.html
What is TFL expire ? I want definition
ReplyDeleteIt is updated in the above post.
DeleteTfl is calculated from dos
ReplyDeleteAnd afl is calculated from dod
What about the corrected claim timely filing
It is mostly calculated from the date of service but for a few insurances, it is calculated from the initial denial date as well.
Deletehi bro sir how many time claim received
ReplyDeleteThe number of times a claim is billed.
DeleteWhat is TFL expire ? I want definition
ReplyDeletePlease check the "Denial Occurrence" section of the above post.
Delete