Timely-filing watch

Outcome

Every claim approaching its payer's filing deadline is identified, the right action (file, expedite, exception-appeal, or write-off-as- expired) is taken, and nothing slips past silently.

Prerequisites

Scope	What it lets you do
billing.claim.read	View the watch
reports.read.operational	See the alerts widget
billing.claim.write	Resubmit / file exception

The payers in your tenant have timely-filing days configured. See the seed values for common commercial payers:

Payer family	Typical TFD
Anthem (commercial)	90 days
UHC (commercial)	90 days
Aetna (commercial)	120 days
Cigna (commercial)	90 days
Humana (commercial)	180 days
Medicaid (state-by-state)	180-365 days
Medicare	365 days

The watch view

/ar/timely-filing lists every claim with a balance, sorted by days remaining ascending.

Column	Source
Claim	ID + payer claim control # if known.
Member	Name + ID.
DOS	Earliest charge DOS.
TFD	Configured per payer.
Filed	Original submission date.
Days remaining	TFD − (today − DOS).

The dashboard's Timely-filing alerts widget aggregates by remaining- days buckets:

Bucket	Action
14+ days	Watch.
7-14 days	Act now — file or expedite.
0-7 days	Escalate; final push.
Negative (expired)	Write off or exception-appeal.

The decision

Steps — pre-expiration

1. Open /ar/timely-filing?days_remaining=<14.

2. For each row, decide:

   State	Move
   Never submitted	Submit now; resolve any NEEDS_FIX charges first.
   Submitted, never accepted	Resubmit; or contact partner.
   Accepted, no 835	Send 276 + tag tf-watch.
   Denied	Triage; appeal if appropriate.
   Partially paid, balance dispute	Appeal if you have evidence.

3. Set short follow-up dates (1-3 days) so these don't drift again.

Steps — expired

For claims with days_remaining < 0:

1. Determine if a TF exception is on the table. Most payers accept TF exceptions for: provider error documented, payer error documented, mass-event evidence (system outage, hurricane, etc.).

2. If yes, file appeal — see 5.5 — File an appeal. Use Reason: timely filing exception with documentation.

3. If no, write off — see 5.6 — Write off with reason with reason timely-filing-expired.

Bulk write-off of expired

The platform supports a Bulk write-off expired TF action (gated by supervisor approval). Use sparingly — many of those rows are defendable.

Validation

Check	Expected
Days-remaining recalculates daily	Yes.
Bucket transitions trigger dashboard alerts	Yes.
Audit log captures TF-expiration write-offs distinctly	Yes; reporting groups them.
Email alert fires when bucket count crosses tenant threshold	Yes (tenant config).

Troubleshooting

Symptom	Cause	Fix
Days-remaining is wrong	Payer TFD config is wrong	Tenant Manual → Payers; ask admin to update.
Some claims missing from watch	They're under a payer with no configured TFD	Same fix; without TFD config, no alert.
Bulk expired write-off failed	Some rows in APPEAL_PENDING	Process those manually first.
Alert email never arrived	Schedule disabled	See 8.3 — Scheduled email.

Where to next

• 6.4 — Claim status inquiry (276/277) — the most useful tool for the 7-14 day bucket.
• 5.5 — File an appeal — the TF- exception path.