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Physician Payment Resource Center

  • Issues with Insurance Payments? TMA Can Help.

    TMA’s free Physician Payment Resource Center (PPRC) goes to bat for members by helping resolve insurance payment issues. Don’t waste your time filing appeal after appeal without resolution. TMA recovered more than $3.8 million for Texas practices in 2023.

    Looking for the Hassle Factor Log / Reimbursement Review and Resolution Service? You’re in the right place! The renamed Physician Payment Resource Center features additional staff experts to better serve our members.

  • Payment Services

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    TMA can help resolve issues with your payer network status, prompt-pay, and other reimbursement claims. Staff experts will work with your team to systematically navigate billing and coding requirements. We also meet directly with Medicare, Medicaid, health care payment plans, and large insurers to discuss specific problems that you bring to our attention.

    Request Payment Services  

  • Submit a Payment Review Form MembersOnlyRed

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    The Texas Medical Association accepts submissions to the Physician Payment Resource Center from current TMA members only. Download the Payment Review Form which includes submission information. All physicians must also have a Business Association Agreement (BAA) on file with TMA.

    Business Associate Agreement (BAA)

    Submit Payment Review Form

  • Payment Services – User Guide

    Please observe the following guidelines to help staff expedite processing while maintaining the integrity and credibility of the Physician Payment Resource Center.

    • General Guidelines 
       
      • The Texas Medical Association accepts Payment Review Forms from current members only.
      • Payment Review Forms may be faxed to (512) 370-1632 or submitted via secure file-drop; https://files.texmed.org/filedrop/pprc.
      • Unless you are submitting an “informational only” Payment Review Form, please exhaust and document reasonable attempts to resolve your claim issues, including the appeals process, before submission. 
      • Clearly identify health plans and/or contractual relationships on the Review 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 Payment Review Forms within two to four weeks of receipt. TMA cannot guarantee a response from the health plan. 

  • Best Practices When Submitting Attachments

    Attachments should contain only the protected health information (PHI) that is relevant to the patient(s) for which a physician is submitting a Payment Review Form. Physicians should delete all other patient information from the attachments. TMA will return to the practice any Payment Review Forms that have non-pertinent PHI.

    Use this checklist to gather the necessary documentation for the Payment Services team.

    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  
    • Appeal

  • Informational-Only Payment Review Forms 

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    TMA adds the following types of Payment Review Forms to its database as “informational only”:

    • The Payment Review Form 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 on the claim in a timely manner.
    • The information submitted is a copy of a complaint filed with the Texas Department of Insurance.
    • The concern is not clear, legible, or understandable.
    • The Payment Review Form contains unclear issues and /or conflicting information.
    • Physician billing errors are construed as payer hassles.
    • The Payment Review Form lacks appropriate attachments.
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    TMA is helping to strengthen your practice by offering personal advice and creating a climate of medical success across the state. 

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  • Billing and Coding Hotline

    Members can speak directly with TMA's certified coders and staff experts about regulatory compliance, billing and coding, payments, and licensure concerns.

    512-370-1414

     

  • PPRC Statistics

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  • Educational Quick Tips

    Billing and Coding Tips, Tools, and Resources

    How can you and your staff know what to do with varying and constantly changing billing and coding requirements? TMA’s payment specialists are here to help. View TMA curated educational resources to help you keep current.

    View TMA Quick Tips

  • Contact TMA Payment Services

    Questions about regulations or best practices? Contact the Payment Services Department at 512-370-1414 or via email.

    E-mail Us

  • Meet Your Payment Specialists

    • Carra Benson, MS, CPC, CDEO, CPMA, CDEO, is a practice management associate with approximately 20 years’ experience in health care, working with physician practices and in hospital systems. Her expertise includes revenue cycle management, coding and documentation audits, credentialing, staff training, and practice operations.
    • Mary Fox, CPC, is a reimbursement specialist with more than 20 years’ experience working with medical billing, coding, and credentialing spanning multiple specialties. Having had the opportunity to work in all aspects of the medical billing cycle, she is equipped with critical working skills and expertise to assist in claims resolution and staff education. She holds a bachelors’ degree from The University of Texas at Austin and is certified as a professional coder by the American Academy of Professional Coders.
    • Alexis Harvey, CPC-A, is a physician payment service coordinator. She specializes in advocating for and educating physicians and their staff about current and emerging issues involving coding, billing and payment transactions. She is dedicated to helping physicians optimize practice profitability and operational efficiency, using her analytical skills and customer service experience to support their success. Alexis holds a Certified Professional Coder Apprentice (CPC-A) designation from the American Academy of Professional Coders and has completed the Schreiner University Medical Billing and Coding Program.

  • Helpful CME from TMA