Quick recap

The meeting focused on billing challenges and insurance reimbursement issues across behavioral health organizations. Participants discussed problems with Texas Children's denying claims and their inability to speak directly with the claims department, as well as discrepancies in payment amounts from the state comptroller's office. Carrie shared information about higher-paying billing codes for residential services, particularly H0018, which pays significantly more than Medicaid rates. The group explored the possibility of bringing in an expert to provide training on billing codes and private insurance practices. They also discussed recent rate increases for Medicaid services that took effect March 1, 2026, though most rates remained unchanged for residential services.

Next steps

• Carrie: Send the VA billing code and rate spreadsheet to Anna (or Noelle), who will distribute it to the full group.

• Noelle/Anna: Distribute Carrie's billing code and rate spreadsheet to all meeting participants and those who could not attend.

• Carrie: Call Texas Children's claims department to attempt direct contact and report back on accessibility.

• Noelle: Reach out within the network to identify and invite a knowledgeable billing/coding professional (e.g., from Hacienda, Cenikor, Lifetime Recovery) to a future meeting for training or Q&A on billing codes and rates, especially for private insurance.

• All participants: Review and provide input/ideas on the draft document for HHSC sunset review comments (as referenced by Noelle).

• Noelle: Start a comprehensive list of frequently used billing codes for group comparison and reference.

• Ivonne/Team: Investigate discrepancies in payment amounts between HHSC approval and state comptroller payments, including checking client financial data for possible secondary payers as suggested by Kathy.

• Quincy: Verify and report back the exact amount paid for the H0018 code to the group.

Summary

El Paso Meeting Planning Discussion

Noelle and Ivonne discussed plans to potentially hold a future meeting in El Paso, with Noelle expressing interest in visiting in May. Ivonne shared her busy work schedule and mentioned that Lucy would not be joining the meeting due to a scheduling conflict. The conversation briefly touched on previous discussions about challenges with Medicaid billing and translation between insurance providers, though specific details were not elaborated upon due to technical difficulties with the meeting platform.

New Women's Residential Facility Update

The meeting began with participants waiting for everyone to join, including Carrie who arrived late due to an open house event for their new women's residential facility. Carrie shared details about the new 10-bed facility, describing the decoration process and upcoming ribbon-cutting ceremony with the chamber. Ivonne introduced herself as CEO of Alliblane in El Paso and mentioned the possibility of hosting a future meeting in El Paso, noting the hot weather conditions.

HHSC Billing Denial Challenges

Carrie shared a challenge with HHSC billing, explaining that Texas Children's Hospital is denying claims with new unfamiliar denial codes (H0005 and others) after previously requiring them to pay $18,000 in unpaid claims following a successful complaint last year. Carrie emphasized the importance of following up on re-credentialing processes to avoid similar issues, noting that lack of follow-up had led to their previous network exclusion problem.

Code Communication and Rate Negotiations

Kathy reported receiving 34 emails regarding codes H005 and H004 since February 2nd, with the claim department allegedly refusing to communicate with providers. Carrie questioned this claim, noting she had never heard of such a policy. The discussion then shifted to code 80018 for residential treatment, with Carrie explaining that while they had used this code once for Aetna, they are currently renegotiating rates with Aetna as their contract from 2012 had not been updated. Carrie shared CMS rates for various H codes, including H0015 for IOP at $291 per day and code 80018 at $1,147 per day, which she is using to negotiate new rates during their re-credentialing process.

Billing Strategies and Insurance Challenges

The group discussed billing strategies and challenges with Medicaid and private insurance claims. Carrie shared information about higher-paying billing codes (H0018 and H0019) that could be used for residential behavioral health services, which pay significantly more than current codes like H2035. The team agreed to investigate bringing in an expert to provide training on private insurance billing practices and codes. Kathy reported ongoing issues with OptumPay regarding a duplicate payment claim, and the group discussed challenges with Texas Children's managed care organization's claim department access and inconsistent denial reasons. The conversation ended with Carrie sharing that recent Medicaid rate increases took effect March 1, 2026, though most residential care codes remained unchanged.