Turn to TMA to Resolve Prompt-Pay Issues
By David Doolittle


If you or your practice is dealing with prompt-pay or other health plan problems, the Texas Medical Association can help resolve those issues through TMA’s Reimbursement Review and Resolution Service (formerly known as the Hassle Factor Log program).  

The Texas Department of Insurance (TDI) last week released a bulletin reminding plans that a portion of prompt-pay penalties must be paid to the state. 

“State law does not allow prompt pay penalties owed to the State of Texas to be waived by a provider contract or through a dispute settlement,” the bulletin said. 

Texas prompt-pay law generally requires insurers to pay clean claims within 30 days of receipt of the claim electronically or 45 days of receipt of the claim non-electronically or face penalties.  

Penalties are tiered, based upon how late the payment is. They are payable to the physician, and, for claims in the latest tier, interest on penalties is payable to TDI. The agency uses interest on penalties to improve access to health coverage for people without it. 

TMA and Harris County Medical Society last year intervened with state insurance regulators after one plan’s inability to pay claims on time kept physicians waiting on millions of dollars

Thanks to those efforts, TDI in April dealt Molina Healthcare of Texas an administrative penalty of $500,000 – on top of almost $8 million combined that the insurer paid in penalties and interest to TDI, and to affected physicians and health care providers. 

TMA also reminds physicians and their staff that Texas prompt-pay laws require fully insured plans to identify themselves as such with the letters “TDI” or “DOI” somewhere on the front of the patient’s ID card. 

Find more information on prompt pay in Texas on the TDI website

And be sure to visit TMA’s website for more prompt pay information and information about other TMA member benefits, products, and services.

Last Updated On

September 23, 2020

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David Doolittle


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Dave Doolittle is editor of Texas Medicine and Texas Medicine Today. Dave grew up in Austin, where he attended culinary school as well as the University of Texas. He spent years covering Central Texas for the Austin American-Statesman newspaper. He is the father of two girls, a proud Longhorn, and an avid motorsports fan.

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