Arbitrary. Confusing. Frustrating. Never-ending. Maddening. Those are some of the terms we can actually print that describe physicians’ perceptions of insurance companies’ prior authorization requirements and approval processes.
Your personal stories of patient harm due to prior authorization request delays or denials can give the Texas Medical Association the ammunition it needs to fight this problem.
Every day, patients pay a hefty price for their health care, and many are quick to blame rising costs and climbing insurance premiums on the first person that comes to mind: usually the “well-paid physician.”
Don’t let your patients place blame on you unfairly.
Arguably one of the biggest issues Texas lawmakers tackled this session was surprise billing, as they vowed to protect patients from receiving medical bills for care not covered by insurance.
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 Hassle Factor Log program.
Although Blue Cross and Blue Shield of Texas (BCBSTX) places limits on the additional fees participating network physicians can charge BCBSTX patients, some are allowed when you provide concierge services.
As a result of recent changes in federal regulations, short-term health insurance plans aren’t so “short” anymore.
Traditionally, short-term plans were meant to act as stop-gap coverage for 30 to 60 days, and were usually purchased by workers between jobs. Now short-term plans can be sold for up to 364 days, and can be renewed for up to 36 months.
Protect Patients From Inadequate, Narrow Networks(TMA Testimony on SB 1264 by Jason Terk, MD)
Expand Access to Care to All Texans Who Need It(TMA Testimony by Doug Curran, MD, March 5, 2019)
Free Market Insurance Solutions Must Protect Texans(Hearing to Review Interim Charge 2: Health Insurance Market Stability Testimony by Ray Callas, MD, Jan. 24, 2018)
Information Accuracy and Oversight Will Minimize Surprise Billing(Testimony on Interim Charge by Ray Callas, MD, Jan. 23, 2018)
TMA Asks Legislators to Make Sure New Step Therapy Law Works(Testimony on Interim Charge No. 6 by Arlo Weltge, MD, Dec. 6, 2017)
Understanding Limitations on Price Transparency(Interim Hearing on Data Collection and Price Transparency by David Bryant, MD, March 21, 2017)
Ban Virtual Credit Cards
ACA Exchange Plans: Q&A for Texas Physicians - Updated December 2015
Physicians Prepare for Round Two of the ACA Marketplace
TMA Healthy Vision 2020: Establish Fair and Transparent Insurance Markets
TMA Develops Tooklit to Help You Challenge Unfair Rankings
Get the latest news on health insurance from TMA.
See TMA's plan of attack, an interview with TDI's newest boss, and how TMA is keeping insurers honest.
Find out what you need to know about ACA Exchange Health Plans.
Get the latest information on claims and payer policies.
Clear Claim Connection tool from BCBS-TX
Clean Claims 101: Read and Follow the Instructions
Claims Workflow Assistant from AMA
Coverage Coordination Through Availity
CMS-1500 Form: TDI Provides Guidance on Blocks 14 and 15
Humana Consolidates Claims Edits
Insurance Company Transitions: UniCare and TRICARE
Ready to Fill Out the New CMS-1500 Claim Form?
Second-Tier Claims Resolution Unit Can Help UnitedHealthcare Participants
Take Action on Stale Clean Claims
Monitoring the contracted rate in your payer contracts is an important step in managing your revenue cycle. Are you receiving the full payment due to your practice for every claim you file?
Physicians have received more than 2 billion dollars in benefits from the settlement agreements reached with Aetna, CIGNA, Health Net, Humana, Anthem/WellPoint, and many Blue Cross and Blue Shield Plans as a result of class action lawsuits brought against these insurers by 19 state and county medical associations and physician representatives.
Get updates on payer policies.
Get the latest information on health care payment plans and prompt payment.
Get the latest information on physician ranking.
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