- 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.
Using the Form
- Use the current HFL form available on the TMA website.
- Fill out the HFL form completely and legibly.
- Give a brief description of the hassle on the form. If you need to include a more detailed description, attach it to the form.
- You may use one form to submit multiple hassles that address the same issue and are from the same health plan.
- Use separate forms to submit multiple hassles that are dissimilar in nature or are similar but from different health plans.
- Use separate forms to submit hassles from different TMA physician members.
- All HFLs require attachments to be processed.
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.