Quick recap

The meeting addressed ongoing issues with Be Well contracts and private insurance matters, including challenges with contract execution, billing processes, and provider credentialing. The team discussed specific billing problems with CMBHS contracts, including technical issues with claim uploads and incorrect clinic numbers, while also exploring solutions for handling private pay and deductibles with HHSC. Noelle provided updates on discussions with HHSC to align processes and requested action items to improve insurance acceptance, with team members encouraged to reach out for further support.

Next steps

• LUCI to provide Barbara with contact information for Be Well clinic setup in CMBHS.

• LUCI to compile questions for HHSC regarding private insurance billing challenges, including deductible assistance, copay, coinsurance, and admission fees.

• LUCI to include questions to HHSC about insurance not covering recommended services and whether that justifies using HHSC funding.

• Kathy to reach out to Carrie about providing input on insurance billing challenges.

• Noelle to continue discussions with HHSC about aligning HHSC and insurance billing requirements.

• Providers to email Noelle with specific insurance billing challenges to bring to HHSC.

• Providers to contact Casey Stray if CMBHS issues persist.

  
  

Summary

Be Well Contracts and Insurance

The meeting focused on issues with Be Well contracts and private insurance matters. Lucy reported that neither her organization nor Santa Maria had received executed Be Well contracts despite previous promises, and she offered to share contact information about setting up the clinic in CMBHS. The group discussed that while contracts aren't loaded in the system yet, they can continue using CMBHS for billing once contracts are executed. The meeting also touched on ongoing private insurance issues, with Yvonne having recently met with HHSC to discuss potential workarounds for certain problems.

CMBHS Billing and Insurance Challenges

Luci discussed challenges with the CMBHS system regarding billing for non-reimbursed amounts like copays and coinsurance, as it only allows for deductible entry. She highlighted issues with private insurance coverage, particularly for intensive outpatient services and provider acceptance, and raised questions about whether clients could be funded by HHSC in such cases. Barbara noted difficulties billing commercial insurance due to differences from Medicaid requirements and mentioned low numbers of clients with Marketplace insurance. Kathy shared experiences with referrals from other nonprofits and discussed provider credentialing challenges, particularly with CIs.

CMBHS Billing System Challenges

The team discussed ongoing billing challenges with CMBHS contracts. Barbara reported that Santa Maria is experiencing issues with a BPA from fiscal year 25 that has not been uploaded to Columbus due to technical problems, resulting in over $300,000 in unpaid claims. Luci mentioned similar issues with contracts being attached to incorrect clinic numbers, preventing billing for services, with Christopher Martinez identified as the contact person handling the issue. Quincy shared that Lifetime is facing similar problems with fund allocation on line items, with a target resolution date of September 22nd from their contract manager.

HHSC Private Pay and Deductibles

Quincy and Luci discussed the process of handling private pay and deductibles with HHSC. Luci explained that providers can enter the deductible amount in the financial system, and HHSC will pay up to that amount before switching to private insurance billing. Luci noted that there may be discrepancies between HHSC and insurance deductibles due to different rates, which can cause confusion for clients. Kathy inquired about where private insurance rates are obtained, and Luci clarified that rates are only available to credentialed providers through explanation of benefits documents from insurance companies.

HHSC Insurance Billing Process Updates

Noelle provided an update on discussions with HHSC regarding challenges with CMBHS and insurance billing. She explained efforts to align HHSC and insurance processes, noting that while funding is decreasing, using insurance could help recoup funds, and she requested specific action items to make insurance acceptance easier. Noelle asked team members to email her if they continue facing challenges with CMBHS or need support in bringing issues higher up the chain.