MSMA is your third party payer advocacy resource.  

The Claims Advocacy for Physicians (CAP) Committee meets regularly with Medicaid, Medicare, and other health insurance companies to discuss specific problems that you bring to our attention.  Through the CAP Committee, MSMA assists MSMA members  who experience difficulties or hassles with the policies and procedures of various health care payers including Medicaid, Medicare, commercial carriers, HMOs, PPOs, UM/QROs, etc. which are of common concern to the physician community.   

Submitting a claim

MSMA accepts Hassle Factor Issues from current members only. MSMA's Hassle Factor Form is currently available to download and submit manually. Download the Hassle Factor Issue form in PDF format below.

Before a member sends any private health information to MSMA, MSMA requires a signed copy of the Business Associate Agreement to be sent to MSMA’s Director of Practice Strategies, Phyllis Williams at PO Box 2548, Ridgeland, MS 39158 or faxed to 601-853-6746 or pwilliams@msmaonline.com. A copy of the BAA can be found in the downloads section below.
If you have any questions, please contact Phyllis Williams at (601) 853-6733 ext. 322.
 
Hassle Factor Form
(Microsoft Word Document)
Business Associate Agreement
(Microsoft Word Document)

NOTE: This Business Associate Agreement is exclusively for the use of the Mississippi State Medical Association (MSMA) in conjunction with the physicians requesting assistance from MSMA.  This Agreement does not constitute legal advice to anyone other than MSMA itself.  Physicians signing this document may wish to seek their own legal counsel prior to signing the Agreement.  This Agreement is tailored to the specific services provided by MSMA and is inappropriate for any other use.  Any other use, reproduction or distribution of this document by individuals or corporations outside of MSMA is unauthorized.  Should unauthorized use of the Agreement occur, MSMA shall not be liable to anyone for any inaccuracy, error or omission, regardless of cause, including negligence, or for any damages resulting therefrom. 

Hassle Factor User Guide

Please observe the following guidelines to help us expedite processing while maintaining the integrity and credibility of the service.

General Guidelines

  • MSMA accepts issues from current MSMA members only.
  • Exhaust and document reasonable attempts to resolve your claim issues, including the appeals process, before submitting the issue (unless you are submitting as “informational only” as noted below).
  • Clearly identify health plans and/or contractual relationships.
  • 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.
  • MSMA copies the physician on any letter we send a health plan regarding his or her issue. 
  • MSMA generally processes issues within two to four weeks of receipt. MSMA cannot guarantee a response from the health plan.  
  • MSMA nor the CAP Committee does not attempt to negotiate fees or levels of reimbursement for individual physicians or groups of physicians and cannot provide legal or other representation to physicians in any appeal process or administrative or legal proceeding.

Attachments

Attachments should contain only the protected health information (PHI) that is relevant to the patient(s) for whom a physician is submitting an issue. Physicians should delete all other patient information from the attachments. MSMA will return to the practice any HFI forms that have non-pertinent PHI.

Examples of frequently needed attachments are:

  • CMS-1500 claim forms
  • Remittance notices (e.g., EOBs, RAs) 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

Informational Only Hassle Factor Issues

 MSMA adds the following types of HFIs to its database as “informational only”:

  • The HFI was submitted to MSMA 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 timely on the claim.
  • The information submitted is a copy of a complaint filed with the Mississippi Department of Insurance.
  • The hassle is not clear, legible, or understandable.
  • The HFI form contains unclear issues and /or conflicting information.
  • The HFI form lacks appropriate attachments.

The collection and analysis of MSMA member complaints continue to benefit members and all Mississippi physicians by documenting reimbursement hassles. Participation by physicians enhances MSMA's ability to make reimbursement less of a hassle for its members.