For the third year running, the Texas Medical Association’s Physician Payment Resource Center (PPRC) helped recover more than $3 million in claim-specific payments owed by health plans for Texas practices.
In 2025, PPRC staff members were able to help recover $3.3 million for TMA members, close to $200,000 more than the previous year. PPRC Director Carra Benson said that trend should continue in 2026 as “complex cases” continue to increase.
Ms. Benson says changes in insurance companies’ policies, such as those around downcoding, have been among the main drivers increasing the number, and complexity, of cases referred to the PPRC.
Acting as an advocate for practices, PPRC staff review payment review forms submitted by members, determine what specific issues a practice is facing, and then work systematically with representatives for the practice and the payer to help clarify coding and billing rules or contract terms that may be driving the issue.
PPRC also provides a billing and coding checklist and other resources that can be found on its webpage. PPRC staff can additionally meet with member physicians or office staff members to review practices’ billing procedures.
“I truly appreciated PPRC staff taking the time to walk me through additional tools and resources – it made a big difference in understanding and applying them effectively,” said Dusty Specks, office manager for Riverwood Medical Clinic in Bastrop.
Accompanied by feedback from TMA members, PPRC meets regularly with Medicare, Medicaid, major private payers, and other health plans to address various issues that lead to lost revenue for physicians.
“There was one health plan last year, and it was taking them 115 days on average to complete an inquiry,” Ms. Benson said. “We had a payer meeting and presented them with that information. They said, ‘We can't let that happen.’ There was a significant drop on their average days to complete inquiries.”
Last year, staff were able to resolve a pay issue in 32 days on average in comparison to 49 days the year prior.
With faster responses from health plans, last year PPRC’s recovery efforts saved member practices valuable time and resources that could be dedicated to other tasks.
Ms. Benson encourages members to reach out to her staff proactively with any questions they may have to stave off any billing issues before they take place.
“One of the things that I like to tell people is that knowledge can hold more power,” she said. “Call us to ask a simple question such as ‘Where’s this policy?’ or ‘Can you help me understand this policy?’ That’s what we’re here for.”
If you have questions about billing and coding or payer policies, email PPRC or call them at (800) 880-1414, or call the TMA Knowledge Center at (800) 880-7955. Members can also fill out and submit a payment review form initiate a claim review by PPRC.
Please be mindful of state and HIPAA privacy and security requirements when communicating with PPRC, a team of billing and coding staff. TMA and its attorneys do not provide legal services to member physicians or practices.