In case you missed these — here is a roundup of useful items from health care payment plans’ newsletters and updates, compiled by TMA’s reimbursement specialists. If you have questions about billing and coding or payer policies, contact the specialists at paymentadvocacy@texmed.org for help.
Health insurance companies' use of narrow networks and unexpected limits on how they pay for services out of network are leaving Texans with medical bills they didn't expect. A new TMA white paper explores, "How Health Insurance Company Practices Leave You Without the Coverage You Thought You Bought." Written for the layperson, journalist, and policymaker, this easy-to-follow guide connects the dots between insurance company business practices and patients' surprise bills.
Ban Virtual Credit Cards2015 Legislative Testimonies and LettersACA Exchange Plans: Q&A for Texas Physicians - Updated December 2015 Physicians Prepare for Round Two of the ACA MarketplaceTMA Healthy Vision 2020: Establish Fair and Transparent Insurance Markets TMA Develops Tooklit to Help You Challenge Unfair Rankings
Read testimony by Patricia Kolodzey, how TMA educated lawmakers, and how TMA stands up for Texas physicians and their patients.
See TMA's plan of attack, an interview with TDI's newest boss, and how TMA is keeping insurers honest.
Find out what you need to know about ACA Exchange Health Plans.
Get the latest information on claims and payer policies.
Clear Claim Connection tool from BCBS-TX
Clean Claims 101: Read and Follow the Instructions
Claims Workflow Assistant from AMA
Coverage Coordination Through Availity
CMS-1500 Form: TDI Provides Guidance on Blocks 14 and 15
Humana Consolidates Claims Edits
Insurance Company Transitions: UniCare and TRICARE
Ready to Fill Out the New CMS-1500 Claim Form?
Second-Tier Claims Resolution Unit Can Help UnitedHealthcare Participants
Take Action on Stale Clean Claims
Monitoring the contracted rate in your payer contracts is an important step in managing your revenue cycle. Are you receiving the full payment due to your practice for every claim you file?
Physicians have received more than 2 billion dollars in benefits from the settlement agreements reached with Aetna, CIGNA, Health Net, Humana, Anthem/WellPoint, and many Blue Cross and Blue Shield Plans as a result of class action lawsuits brought against these insurers by 19 state and county medical associations and physician representatives.
Get updates on payer policies.
Get the latest information on health care payment plans and prompt payment.
Get the latest information on physician ranking.
Got Commercial Insurance questions? Call the Knowledge Center.