Third Party Payer
MAG's third party payer claims service helps you keep the money you've earned...
- Help with third party payer claim disputes and other grievances
- Assistance with coding, audits, recovery requests, claim processing and adverse payer practices
- Keeping you up to date on traditional Medicare and Medicare managed care, Medicaid and other third party reimbursement systems
MAG’s Health Policy and Third Party Payer Advocacy Department continues to represent MAG members on a number of advisory committees at the state and national levels.
MAG has advised hundreds of practices on ways to resolve payment or practice management problems from an advisory standpoint. MAG also helped a number of practices resolve payment issues with health insurance companies, while MAG’s Third Party Payer Committee continued to address important issues like prior authorization and Medicaid.
The bottom line is that MAG has helped physicians in Georgia save millions of dollars in third party payer claims.
MAG's Business Associate Agreement
Before a member sends any private health information to MAG, MAG requires two original, signed copies of the Business Associate Agreement to be mailed to Bethany Sherrer at 1849 The Exchange, Suite 200, Atlanta, GA 30339 or faxed to 678.303.3732.
Is there a time limit on retroactive requests for payment recoveries by insurance companies?
Yes, an insurer's post-payment claim audit or retroactive claim denial must be completed within 18 months of that date of service or discharge if a provider submits a claim for payment within 90 days of the last date of service or discharge included on the claim.
If the claim was submitted for payment more than 90 days after the date of service or discharge, an insurer's post-payment claim audit or retroactive claim denial must be completed within 18 months of the claim submission date or 24 months after the date of service, whichever is sooner. § 33-20A-62
Claims Recovery Service
The Medical Association of Georgia (MAG) gives state specialty societies the opportunity to join MAG members with access to a unique third party payer claims recovery service.
These state specialty societies pay MAG an annual service fee. MAG charges the physicians that use the service a recovery fee, including 10 percent of the claims that are recovered for members of MAG or the participating specialty societies and 25 percent of the claims that are recovered for non-members. If a practice that includes both members and non-members submits claims for assistance, the individual physician's claims will serve as the basis for the recovery fee (e.g., if physician A is a member and physician B is a non-member, the recovery fee for physician A will be 10 percent while the recovery fee for physician B will be 25 percent).
Practices must exhaust every contractual remedy and appeal before submitting a claim to MAG, and claims information must be submitted to MAG in an electronic format and include…
- A brief synopsis of the issue
- All supporting documentation
- A record of every attempt to collect the unpaid claims
- A signed business agreement that gives MAG the authority to view information that is covered by HIPAA
MAG will not collect money from patients; MAG will only collect money from public and private payers.
MAG does not offer legal advice or practice management training.
For issues not directly related to the recovery of funds, MAG will provide its members and members of participating specialty societies with a preliminary consultation of up to one hour of staff time at no charge.
MAG will refer practices that require more than one hour of staff time to an outside attorney – and the practice will be responsible for any fees that are required by that attorney.
MAG does not charge a fee for referrals.
Physicians can contact Bethany Sherrer at email@example.com to determine if their specialty society participates in MAG’s Third Party Payer Claims Recovery Service.
Georgia Model Managed Care Contract
The Medical Association of Georgia (MAG) and the Georgia Medical Group Management Association (GMGMA) offer A Georgia Model Managed Care Contract on a joint basis as a resource for Georgia physicians. It's designed to help physicians contend with often-overlooked and complicated contract language. The resource is annotated with Georgia statutes and case law, and it includes language from managed care lawsuit settlements in which MAG was an original plaintiff.
A Georgia Model Managed Care Contract is available online on a password-protected basis at no cost to members. The cost for non-members is $350. It can be obtained by contacting Christiana Craddock with MAG at 678.303.9271 or firstname.lastname@example.org.
Click here to access A Georgia Model Managed Care Contract
Click here to access MAG Model Medical Staff Bylaws
MAG cannot provide legal advice or representation to individual members. The information that is provided in this section of the website is intended to serve as useful information. It is in no way intended to serve as legal advice or a legal relationship. You should always discuss specific legal issues with your private health care attorney and your medical malpractice liability carrier for specific advice and recommendations.