Hassle Factor Log

TMA helps you resolve your insurance related problems. TMA meets regularly with Medicare, Medicaid, health care payment plans, and large insurers to discuss specific problems that you bring to our attention.

TMA's Hassle Factor Log is currently available only to download and submit manually. The online Hassle Factor Log is undergoing revision and will be available again shortly. Download the Hassle Factor Log in  PDF  format. All physicians must have a current Business Associate Agreement (BAA) on file with TMA. A copy of the BAA can be found here. If you have any questions, please contact the TMA Knowledge Center at (800) 880-7955.

Hassle Factor Log Program User Guide

Please observe the following Hassle Factor Log (HFL) guidelines to help us expedite processing while maintaining the integrity and credibility of the HFL program.

General Guidelines

  • The Texas Medical Association accepts HFLs from current TMA members only.
  • Submit HFLs by mail to Payment Advocacy Dept., Texas Medical Association, 401 W. 15th St., Austin, TX 78701; or by fax to (512) 370-1632. (You don’t need to mail us originals of faxed information.)
  • Exhaust and document reasonable attempts to resolve your claim issues, including the appeals process, before submitting an HFL (unless you are submitting an HFL as “informational only”).
  • Clearly identify health plans and/or contractual relationships on the HFL form.
  • Keep in mind that Medicare’s Correct Coding Initiative (CCI) determines bundling standards.
  • Do not report slow-pay issues until 45 to 60 days after you have submitted the claim and you have received confirmation that the claim is being processed.
  • TMA copies the physician on any letter we send a health plan regarding his or her HFL.
  • TMA generally processes HFLs within two to four weeks of receipt. TMA cannot guarantee a response from the health plan.

Attachments

Attachments should contain only the protected health information (PHI) that is relevant to the patient(s) for which a physician is submitting an HFL. Physicians should delete all other patient information from the attachments. TMA will return to the practice any HFLs that have non- pertinent PHI.

Examples of frequently needed attachments are:

  • CMS-1500 claim forms
  • Remittance notices (e.g., EOBs, RAs, R&S reports) with definitions of comment indicators and/or denial messages
  • Copies of relevant prior correspondence to and from the health plan, including appeal letters and/or denial letters
  • Reports for proof of timely filing (e.g., batch acceptance reports from the payer or clearinghouse showing the payer accepted the claims)
  • Operative notes/Medical records
  • Patient insurance identification cards
  • Preauthorization/Referral forms

Informational Only HFLs

TMA adds the following types of HFLs to its database as “informational only”:

  • The HFL was submitted to TMA expressly for “informational only” purposes.
  • The claim currently is being appealed with the health plan for the first time.
  • The claim is for services older than 12 months.
  • The physician office failed to follow up timely on the claim.
  • The information submitted is a copy of a complaint filed with the Texas Department of Insurance.
  • The hassle is not clear, legible, or understandable.
  • The HFL contains unclear issues and /or conflicting information.
  • Physician billing errors are construed as payer hassles.
  • The HFL lacks appropriate attachments.

 


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    Dr. Hershkowitz - we haven't received complaints about this particular plan. If you want to send us the specifics through the TMA Hassle Factor Log program, we can review the issue and get in touch with UHC if necessary.

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    We are having a difficult time with United Healthcare Medicare Solutions and I am wondering if all practices are going through this? They state they follow Medicare guidelines but their reasons for denial do not match Medicare at all and they delay most every claim wanting to see medical records. The stall tactics and delays need to stop.

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