Medical Billing Terms T: Timely Filing, TRICARE and Third-Party Liability

Timely filing is the deadline for sending a claim to a payer. This page defines timely filing with the terms from Texas Medicaid STAR to Type 2 NPI, including TRICARE, third-party liability, TPA and the timely filing denial. MCM South Medical Billing Service, LLC works only in mental and behavioral health billing.

Last reviewed: October 10, 2026Sources linked at each term

Get a Free Quote Schedule a Consultation

Billing Terms Glossary slide, Terms T: Timely Filing - MCM South Medical Billing Service, LLC

Glossary pages

0-9 A B C D E F G H I J K-L M N-O P Q-R STU-V W-Z

Pages in T

T-1T-2

On this page (17 terms)

Texas Medicaid STAR
The Joint Commission
TherapyNotes
Third-Party Administrator (TPA)
Third-Party Liability (TPL)
Timely Filing
Timely Filing Denial
T-MSIS
Total Time on the Date of the Encounter
Tracer Methodology
Transcranial Magnetic Stimulation (TMS)
Treatment, Payment, and Health Care Operations (TPO)
Treatment Plan
TRICARE
TriZetto
Type 1 NPI
Type 2 NPI

How to use these Timely Filing definitions

Use this page as a quick reference for Timely Filing, from Texas Medicaid STAR to Type 2 NPI. Each entry gives a plain definition, why it matters to a mental health practice, and an official source. When a rule changes by payer or state, the entry says so, so confirm Timely Filing details with the payer before you bill.

Checklist: put the timely filing definitions to work

Texas Medicaid STAR: Texas is a served state; program names help identify the correct plan.
The Joint Commission: Accreditation can be a payer or state requirement for certain program types.
TherapyNotes: Widely used by solo and group therapy practices.
Third-Party Administrator (TPA): The name on the card may not be the entity that owns the risk or sets the plan rules.

Share this page

Search this page

Texas Medicaid STAR

Medicaid (state-specific)

Also called STAR; STAR+PLUS; Texas Medicaid managed care

Definition: Texas Medicaid managed care programs, including STAR for most children and families and STAR+PLUS for adults with disabilities and older adults.
Why it matters: Texas is a served state; program names help identify the correct plan.
Illustrative example: A Texas provider checks the member's program before billing.

Reference sourceMedicaid.govchecked 10/9/26

CategoriesMedicare & Medicaid Terms BCBS, UHC & Commercial Payer Terms

The Joint Commission

General (all payers)

Also called TJC; Joint Commission accreditation

Definition: A nonprofit that accredits hospitals and other health care organizations, including behavioral health programs.
Why it matters: Accreditation can be a payer or state requirement for certain program types.
Illustrative example: A residential program cites its Joint Commission accreditation to a payer.

Related termsNCQA URAC

Reference sourceThe Joint Commissionchecked 10/9/26

CategoriesCredentialing & Enrollment Quality & Risk Adjustment Terms

TherapyNotes

General (all payers)

Also called Therapy Notes

Definition: A vendor of EHR and practice management software for behavioral health practices. Listed for reference; not an endorsement or partnership.
Why it matters: Widely used by solo and group therapy practices.
Illustrative example: A therapist documents and bills from TherapyNotes.

Reference sourceTherapyNoteschecked 10/9/26

CategoriesEHR & Healthcare Technology Terms

Third-Party Administrator (TPA)

General (all payers)

Also called TPA; claims administrator

Definition: A company that processes claims and manages benefits for a self-funded plan, often under a payer's brand.
Why it matters: The name on the card may not be the entity that owns the risk or sets the plan rules.
Illustrative example: A TPA processes claims and answers questions for an employer's self-funded plan.

Reference sourceU.S. Department of Labor, EBSAchecked 10/9/26

CategoriesBCBS, UHC & Commercial Payer Terms Eligibility & Benefits

Third-Party Liability (TPL)

Medicaid (state-specific)

Also called TPL; Medicaid third party liability; Medicaid payer of last resort

Definition: Third-party liability means another source of coverage, such as a commercial plan, may be responsible for a Medicaid member's health care costs. Medicaid is generally the payer of last resort.
Why it matters: Bill the other coverage first, then Medicaid. Missing another plan on a Medicaid claim can cause a denial or a recovery.
Illustrative example: A Medicaid patient also has an employer plan, so the biller bills the employer plan first.

Reference sourceMedicaid.gov CMS (Centers for Medicare & Medicaid Services)checked 10/9/26

CategoriesMedicare & Medicaid Terms Payment & Reimbursement

Timely Filing

General (all payers)

Also called timely filing limit; filing deadline; claim submission deadline

Definition: The deadline by which a claim must be received by a payer, counted from the date of service or another trigger set by law or contract.
Why it matters: Claims filed late are usually denied and not recoverable.
Illustrative example: A payer's contract allows 90 days from the date of service.

Reference sourceCMS (Centers for Medicare & Medicaid Services)checked 10/9/26

CategoriesClaims Processing Denials & Appeals

Timely Filing Denial

General (all payers)

Also called late claim denial

Definition: A denial because the claim was received after the filing deadline.
Why it matters: Overturned only with proof of timely filing or a valid exception.
Illustrative example: A claim denies as untimely and the practice supplies an acceptance report.

Reference sourceCMS (Centers for Medicare & Medicaid Services)checked 10/9/26

CategoriesDenials & Appeals

T-MSIS

Medicaid (state-specific)

Also called Transformed Medicaid Statistical Information System; Medicaid data reporting

Definition: T-MSIS, the Transformed Medicaid Statistical Information System, is the system through which states report Medicaid and CHIP data to CMS, including claims and encounter data.
Why it matters: Encounter and claims data from providers and plans feed it, so accurate coding and provider data matter.
Illustrative example: A state Medicaid agency reports encounter data from managed care plans through T-MSIS.

Reference sourceMedicaid.gov CMS (Centers for Medicare & Medicaid Services)checked 10/9/26

CategoriesEDI & Clearinghouse Terms Medicare & Medicaid Terms

Total Time on the Date of the Encounter

General (all payers)

Also called total time E/M; time-based E/M; E/M time rule

Definition: Total time on the date of the encounter is the sum of the physician's or other qualified professional's face-to-face and non-face-to-face work on the date of the visit. It can be used to select an office E/M level.
Why it matters: Count only the clinician's own time on that date. Do not count time for a separately reported service, such as a psychotherapy add-on, and do not count travel for a home visit. Document the total.
Illustrative example: A psychiatrist records 32 minutes of total time, including chart review and documentation on the visit date.

Reference sourceAmerican College of Surgeons, E/M office visit time thresholds AMA, CPT code set overview UTHealth Houston, 2023 Home or Residence Serviceschecked 10/9/26

CategoriesClaims Processing

Tracer Methodology

General (all payers)

Also called Joint Commission tracer; patient tracer; survey tracer

Definition: Tracer methodology is a survey method in which reviewers follow a patient's actual experience through an organization to see how the systems work in practice.
Why it matters: Practices prepare by making sure their records and processes match what they say they do.
Illustrative example: A surveyor follows one patient's chart from intake to discharge and asks staff to explain each step.

Reference sourceThe Joint Commissionchecked 10/9/26

CategoriesQuality & Risk Adjustment Terms

Transcranial Magnetic Stimulation (TMS)

General (all payers)

Also called TMS; 90867; 90868; 90869

Definition: A noninvasive treatment for certain depressive conditions using magnetic pulses, billed with specific CPT codes and usually requiring prior authorization.
Why it matters: Has strict payer criteria and documentation.
Illustrative example: A psychiatrist requests authorization for a TMS course.

Reference sourceAmerican Medical Association (AMA)checked 10/9/26

CategoriesBehavioral Health Specific Terms Claims Processing

Treatment, Payment, and Health Care Operations (TPO)

General (all payers)

Also called TPO; treatment payment operations HIPAA

Definition: Treatment, payment, and health care operations, or TPO, are the routine purposes for which HIPAA lets a covered entity use and share protected health information without a patient's written authorization.
Why it matters: Billing a claim is payment. Psychotherapy notes are treated differently and generally need an authorization. Share only the minimum necessary for payment and operations.
Illustrative example: A practice sends diagnosis and session dates to an insurer to get paid, which falls under payment.

Reference sourceHHS (U.S. Department of Health and Human Services)HHS Office for Civil Rights (OCR)checked 10/9/26

CategoriesAudits & Compliance

Treatment Plan

General (all payers)

Also called plan of care; individualized treatment plan

Definition: A written plan that lists a patient's goals, interventions, and expected duration, updated as care progresses.
Why it matters: Many payers and Medicaid programs require current plans to support continued care.
Illustrative example: A therapist updates a treatment plan every set period as payer rules require.

Reference sourceAmerican Psychiatric Associationchecked 10/9/26

CategoriesBehavioral Health Specific Terms Audits & Compliance

TRICARE

Private payer

Also called military health system; TRICARE billing

Definition: The health care program for uniformed service members, retirees, and their families, administered through regional contractors.
Why it matters: Has its own network, authorization, and claim rules separate from Medicare and commercial plans.
Illustrative example: A therapist enrolls with the TRICARE contractor for the region.

Reference sourceTRICAREchecked 10/9/26

CategoriesMedicare & Medicaid Terms BCBS, UHC & Commercial Payer Terms

TriZetto

General (all payers)

Also called TriZetto Provider Solutions

Definition: A health care technology company offering clearinghouse and payer and provider software. Listed for reference; not an endorsement or partnership.
Why it matters: Appears in clearinghouse and payer instructions.
Illustrative example: A payer accepts claims from TriZetto.

Related termsClearinghouse Payer ID

Reference sourceTriZetto Provider Solutionschecked 10/9/26

CategoriesEDI & Clearinghouse Terms

Type 1 NPI

General (all payers)

Also called individual NPI; individual provider NPI

Definition: The NPI assigned to an individual health care provider, such as a psychologist, therapist, or psychiatrist. A person can have only one.
Why it matters: It identifies the treating or rendering clinician on claims.
Illustrative example: A solo therapist bills under a Type 1 NPI as both rendering and billing provider.

Reference sourceCMS (Centers for Medicare & Medicaid Services)NPPES (NPI Registry)checked 10/9/26

CategoriesProvider Data Management Terms

Type 2 NPI

General (all payers)

Also called organizational NPI; group NPI

Definition: The NPI assigned to an organization, such as a group practice or clinic, that bills for services.
Why it matters: Group claims list the Type 2 NPI as the billing provider, while the individual's Type 1 NPI is the rendering provider.
Illustrative example: A group therapy practice bills under its Type 2 NPI with each therapist's Type 1 NPI as rendering.

Reference sourceCMS (Centers for Medicare & Medicaid Services)NPPES (NPI Registry)checked 10/9/26

CategoriesProvider Data Management Terms

Quick answer: Timely Filing

What is timely filing?

Timely Filing is the deadline by which a claim must be received by a payer, counted from the date of service or another trigger set by law or contract. Claims filed late are usually denied and not recoverable.

Frequently asked questions: Timely Filing

What is third-party liability?

Third-party liability means another source of coverage, such as a commercial plan, may be responsible for a Medicaid member's health care costs. Medicaid is generally the payer of last resort. Bill the other coverage first, then Medicaid.

What is a Type 2 NPI?

The NPI assigned to an organization, such as a group practice or clinic, that bills for services. Group claims list the Type 2 NPI as the billing provider, while the individual's Type 1 NPI is the rendering provider.

What is TRICARE?

TRICARE is the health care program for uniformed service members, retirees, and their families, administered through regional contractors. Has its own network, authorization, and claim rules separate from Medicare and commercial plans.

Related resources

Where MCM South works

MCM South serves psychotherapists and psychiatrists in ten states: Georgia, Massachusetts, Connecticut, Texas, Florida, New York, Colorado, Tennessee, North Carolina and Illinois.

Get a free mental health billing quote

MCM SouthGet a Free Quote