Debt Collection  Timely Filing Waiver

Debt Collection Timely Filing Waiver PowerPoint PPT Presentation


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Debt Collection Timely Filing Waiver

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1. One Team, Many Challenges, All Committed Debt Collection & Timely Filing Waiver

3. Debt Collection TMA Aurora Resources (DCAO Reps) 303-676-3566 303-676-3544 TRICARE Management Activity Beneficiary & Provider Services 16401 East Centretech Parkway Aurora, CO 80011-9043 Fax: 303-676-3598

4. Timely Filing Waiver Timely Filing Waivers A Timely Filing Waiver (TFW) is required for all claims over one-year from date of service or date of discharge. Director of Customer Communications (C&CS) has approval/signatory authority to grant a TFW if the TFW Exception Criteria is met. All TRICARE Contractors have authority to grant a TFW if the TFW Exception Criteria is met.

5. Timely Filing Waiver Waiver Authority Timely Filing Deadline Title 32, CFR, Part 199.7 (d)(2) Good Faith Payments Title 32, CFR, Part 199.11 (f)(5) Signature Requirement Title 32, CFR, Part 199.7 (c)(1)

6. Timely Filing Waiver Waiver Authority Override of information contained on DEERS based on appropriate documentation regarding TRICARE/ CHAMPUS law, regulation, and policy.

7. Timely Filing Waiver TFW Exception Criteria TRICARE Operations Manual, Chapter 8, Section 3, Paragraph 2. 2.1 Retroactive Determinations Retroactive determination must have been obtained/issued after the timely filing period elapsed (one-year from services)

8. Timely Filing Waiver TFW Exception Criteria TRICARE Operations Manual, Chapter 8, Section 3, Paragraph 2. 2.2. Administrative Error Administrative error is based on the belief that the claimant had been prevented from filing timely due to misrepresentation, mistake or other accountable action of an officer or employee of TMA (including TRICARE Overseas) or a contractor, performing functions under TRICARE and acting within the scope of that individual’s authority.

9. Timely Filing Waiver TFW Exception Criteria TRICARE Operations Manual, Chapter 8, Section 3, Paragraph 2. 2.3. Inability To Communicate and Mental Incompetency For purposes of this waiver, mental incompetency includes the inability to communicate even if the result of a physical disability. Physician statement attesting to the beneficiary’s mental incompetency is required for the waiver.

10. Timely Filing Waiver TFW Exception Criteria TRICARE Operations Manual, Chapter 8, Section 3, Paragraph 2. 2.4. Provider Change From Non-Participating To Participating A participating provider must submit a request to have the non-participating claim changed to participating.

11. Timely Filing Waiver TFW Exception Criteria TRICARE Operations Manual, Chapter 8, Section 3, Paragraph 2. 2.5. Other Health Insurance (OHI) OHI claim must be submitted to TRICARE within 90 days of the OHI adjudication date on the OHI EOB.

12. Timely Filing Waiver TFW Exception Criteria TRICARE Operations Manual, Chapter 8, Section 3, Paragraph 2. 2.6. Dual Eligibility With Medicare A waiver for timely filing is automatically granted if Medicare accepted the claim as timely and TRICARE receives the claim within 90 calendar days from the date of Medicare’s adjudication.

13. Timely Filing Waiver TFW Reviews (TMA Aurora) All TFW requests are reviewed on the documentation provided and/or circumstances provided in the inquiry. All TFW requests are researched in PCDIS (TMA Claims System) and through contact with the TRICARE Contractors.

14. Timely Filing Waiver TFW Reviews (TMA Aurora) If the documentation/circumstances do not fall within the TOM TFW Exception Criteria, the request will be denied. However, in many cases, the request does not provide any additional documentation on why the claim was not filed timely or any circumstances surrounding the filing of the claim. In these situations, we advise the claimant (beneficiary/ provider/DCAO/BCAC) of the TOM Exception Criteria and if they can provide some proof that meets any of the criteria, a subsequent review will be completed.

15. Timely Filing Waiver Proof of Timely Filing Obtaining proof of timely filing can be difficult, especially when the services were provided years earlier. The burden of proof rests with the beneficiary, but the DCAO/BCAC can assist by contacting the provider and/or collection agency for billing notes, TRICARE denial letters, etc. A provider can usually provide a screen print of their billing history showing the claim was filed timely or any contacts they made during the one-year filing period.

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