TMA Staff Averts Medicaid Claims Nightmare

When the claims clearinghouse Availity inadvertently cut its connection to the Texas Medicaid & Healthcare Partnership (TMHP) last month, more than 30,000 claims totaling $23 million filed by physicians and other health care professionals in just four days were in danger of disappearing. And, the number of claims was increasing by the hour. 

But Availity knew who to call – Genevieve Davis, director of TMA's Payment Advocacy Department. She notified TMA Director of Government Affairs Helen Kent Davis, who immediately found someone at TMHP who could help resolve the issue. 

"In fact, due to the quick action of TMA and the valuable relationships we have established with health plans and vendors, someone from TMHP contacted Availity the same day," said Lee Spangler, TMA's vice president for medical economics, adding that by the next day, "Availity and TMHP staff were working together to fix the connection." By the end of the week, Availity confirmed it had successfully submitted all the claims to TMHP, thus preventing payment disruptions and the need for resubmitting claims. 

"This behind-the-scenes work between TMA, Availity, and TMHP helped physicians continue to get paid for the services they provide," Mr. Spangler said.

What TMA did in the Availity case is just one example how TMA's staff of experts can help resolve claims-payment problems. In 2011, for example, TMA pushed insurers to save practices more than $20 million. It also recovered $1.6 million for thousands of doctors through the Hassle Factor Log program, including money recovered from incorrectly processed claims, lost or delayed Medicare enrollment applications, and other payment issues. Just email TMA Payment Advocacy for assistance.


 Action, June 4, 2012 


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