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).
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 intervened with state insurance regulators after one plan’s inability to pay claims on time kept physicians waiting on millions of dollars. Physician members and their practice staff can access help with reimbursement hassles using the Reimbursement Review and Resolution Service.
Thanks to this type of service, TDI 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, or turn to TMA for other member benefits, products, and services.
Last Updated On
May 19, 2022
Originally Published On
July 22, 2019