Hassle Factor Log Program User Information

General Guidelines

  • The Texas Medical Association accepts HFLs from current TMA members only.
  • Submit HFLs by fax to (512) 370-1632; or by secure file-drop at https://files.texmed.org/filedrop/RRR.

  • 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 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.  

Last Updated On

August 04, 2020