Quick recap
The meeting focused on credentialing and billing challenges with MCOs in Texas. Carrie described repeated re-credentialing demands from Texas Children’s via Versi (CVO), despite a recent re-contracting and a letter stating credentialing was valid through 2028, and raised concerns about alignment of cycles and possible outdated information. She also discussed ongoing underpayment issues with UnitedHealthcare on H0004 and the need for a provider complaint. Kathy shared prior authorization problems with Molina and WellPoint, including conflicting approval notices and difficulties using Availity. LUCI and others discussed Availity’s unreliability, inconsistent processes across MCOs, and the time-consuming nature of credentialing and authorizations. The group compared billing systems, with LUCI noting use of Metasoft and mention of EHRs that integrate with CMBHS, while Carrie expressed dissatisfaction with Athena’s payment routing. Participants highlighted the need for better data and communication with HHSC and MCOs, and the historical context of Texas Medicaid’s fraud-related policies…
We have our own billing department, so unfortunately I don’t have a billing company I can personally recommend. However, we work extensively with MCOs, Medicaid, and commercial insurance.
I would recommend finding a company with specific SUD and behavioral health experience, particularly with credentialing, authorizations, denials, and A/R follow-up. Also, pay close attention to their fee structure. Many billing companies charge a percentage of collections, typically around 5% to 10%, depending on volume and the services included.