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Physician/Provider Information and Advice for Physicians and Providers- Tips

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Know Your Claim Filing Requirements

  • Know your contractual obligations, including where to file claims, claim filing deadlines and your fee schedule.
  • File claims to the correct claims filing address.
  • File claims with carriers in a timely manner.
  • File claims using a method that will document when the claim was received by the carrier.
  • Keep records of your phone conversations and all written correspondence with each carrier regarding the status of a claim.
  • Update your accounts receivables as soon as claim payments are received.
  • Don´t submit duplicate bills. If there is a genuine need to send a duplicate bill to a carrier, mark it clearly as a duplicate.

Keep Documentation for Filing Complaints

Be sure to include the following when filing a complaint with the Texas Department of Insurance (TDI) regarding a delay in claim payment:

  • A copy of the patient´s health insurance ID card.
  • A copy of the claim submitted to the company for each patient and date of service.
  • Evidence of claim submission in the form of:
    • Electronic transmission confirmation,
    • Certified mail return receipt, or
    • Courier delivery confirmation.
  • Evidence of your collection activities for each claim prior to contacting TDI. That evidence should be in the form of:
    • Documentation of phone conversations made to the health carrier.
    • Copies of correspondence mailed to the health carrier.
    • Replies you have received from the health carrier.

Be sure to separate claims by the HMO or insurance carrier name. Claims for one HMO or insurance carrier must be grouped together and alphabetized by the patient's last name. If there is more than one claim for the same patient, please staple the claims together.



For more information, contact:

Last updated: 11/08/2014

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