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Insurance Advocacy

TMA's advocacy team works on behalf of members to address systemic insurance issues and help physicians navigate the increasingly complex and cumbersome necessity of doing business with health plans. From network contracting to reimbursement to insurance-related rules and regulations, TMA constantly monitors the payer landscape and works to ensure fair business practices for Tennessee’s doctors and their patients. It's not just about getting claims paid; it's about holding insurance companies accountable, and facilitating relationships between physicians and carriers. 

TMA is an advocate for physicians on a number of insurance-related issues:

  • Reimbursement disputes or claims issues 

  • Alleviating administrative hassles 

  • Solving health plan network contracting issues 

  • Developing influential and effective contacts with health plans

Overview of CY 2023 Medicare Physician Fee Schedule (MPFS) and Quality Payment Program Final Rule (QPP)

  • The new year means new rules and regulations for reimbursement. TMA has teamed up with the Physicians Advocacy Institute (PAI) and Healthsperien to provide a webinar that breaks down CY 2023 rules from the Centers for Medicare & Medicaid Services (CMS) and what they mean for your practice. Watch the webinar here.

Clinical Geonomics

Prior Authorization

  • Prior Authorization: Learn more about this significant issue and how TMA is promoting administrative simplification.

Insurance Resources & Guides

  • Insurance & Healthcare Law Guide: Find TMA Guides on Cancer Insurance, Credentialing of Physicians for Commercial Insurance Plans, Tiering by Insurance Plans and more in the TMA Law Guide Directory. (Member Login Required)

  • CPT®: Understanding the CPT Code Set and its Place in Medicine: This free AMA webinar will help members understand how these codes, reported by physicians and used by health plans, health technology companies and others, respond to changes in the health care landscape, spark and spur innovation, and serve to advance health equity efforts. Download materials here.

  • Coding and Billing Guidelines during COVID-19: This PDF and slideshow created by TMA and LBMC outlines coding and billing guidelines that may have changed due to the pandemic.  

  • Annual Wellness Visit Resources: These physician and patient-specific guides explain how third parties are interfering with Medicare Annual Wellness Visits and next steps if this happens to your patients.

  • Guide to BCBS Professional Agreement: The TMA legal department has developed a summary guide to the BlueCross BlueShield of Tennessee, Inc. Professional Agreement (or Contract). The resource gives members an executive summary of the provisions of the Agreement, an analysis of some terms, and discussion of potential pitfalls in this or any managed care contract.

  • Guide to the 2019 Provider Stability Act: This brief document helps physicians and medical practices understand how to comply with the Healthcare Provider Stability Act, a first-of-its-kind law that requires more transparency and limits changes to reimbursement rates in contracts between health insurance companies and healthcare providers.

  • Guide to the 2015 Credentialing Law: Insurance plans must provide information required to complete a physician’s credentialing application within a specific timetable. TMA’s guide discusses the requirements in detail.

  • Tennessee Health Care Innovation Initiative (Payment Reform): TMA has advocated since 2012 to improve the design and implementation of the state's move from fee-for-service to a payment model based on episodes of care.

Insurance Toolkits

  • ERISA Physician Toolkit: TMA’s new Employment Retirement Income Security Act Toolkit is full of samples for filing appeals, claims and complaints.

  • Medical Audit Toolkit: This toolkit provides practical information and tips to guide physicians in anticipating medical audits, responding to auditor's requests for medical records, and appealing erroneous audit findings. 


This virtual event will provide members with critical information on E/M documentation, avoiding appeals and recoupments, proper coding and more. Don't leave money on the table!

Learn More


E/M Services: Current vs. Future Regulations

This online course aims to clarify changes to E/M services that became effective Jan. 1, 2021.

Register Here


Contact Us

Tabitha Lara
Director of Insurance Affairs