TFG definition
Examples of TFG in a sentence
As further outlined in the Terms and Conditions, the Customer hereby agrees to the following: The Bank may amend this Agreement unilaterally by publishing an updated agreement in TFG (please see Clause 19 of the Terms and Conditions); Each Nordea Company is entitled to communicate with the Customer by e-mail to the Customer’s e-mail address stated above (or as otherwise notified to any Nordea Company) for all purposes (within and outside the scope of TFG).
All sample claims require further investigation through review of Anthem and Delta’s claim documentation (typically additional detail not on the claims tape such as case management notes or plan sponsor emails explaining exceptions or approving any deviations from the plan benefit design), or access to the member history file, which is done on-site by TFG Partners.
After identification of the high-cost claims and claimants, TFG Partners will confirm member eligibility, and check that all prior authorization criteria have been met.
TFG Partners will obtain a copy of SJVIA’s Administrative Services Agreements from SJVIA and review the documents within the context of the audit services and other contract compliance provisions.
TFG Partners will conduct three levels of electronic duplicate and erroneous payment reviews at both the individual claim summary and claim detail (line item) level.
For the dental audit, TFG Partners reviews dentally specific medical logic (e.g., extraction of same tooth twice), procedural frequency limits (e.g., root canals), bundling, and unbundling of procedures.
In this process, TFG Partners will confirm adjudication exceptions and identify any deficiencies that support the findings of the electronic audits.
The parties agree that the Addendum to the GSA dated as of July 13, 2005, as later amended as of January 23, 2007 (sometimes called the TFG Addendum) was terminated as of August 29, 2008, and neither party has any further obligations thereunder.
TFG Partners will review all procedure codes in relation to the diagnostic documentation for appropriateness (i.e., to determine whether procedures performed supported by the diagnostic codes) and check for unusual high medical supply charge outliers (e.g., pacemakers, prostheses).
Additionally, TFG Partners will review the claim history of each SJVIA plan member with a high dollar claim, to review the total available cost for the treatment episode of which the high dollar claim is part.