Hello All!

Wondering if any of you know of any billing companies or people who are willing to contract with us to help with credentialing and billing. We have been primarily a SUD provider mostly using MCO's. We are now adding behavioral health services and expanding to commercial insurance and would like some guidance. Or if anyone here is available to answer a few questions for me relating to this, that would be great.

My email is nyarbrough@youth180tx.org.

Thanks all!

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and a letter stating credentialing was valid through 2028, and raised concerns about alignment of cycles and possible outdated information.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…

Baylor Scott & White and FirstCare will no longer participate in the Texas Medicaid STAR program effective August 31, 2026. Providers serving members in Lubbock, MRSA West, or MRSA Central should verify member MCO assignments before September 1 and update EVV authorizations and billing information accordingly.

Is anyone anticipating operational or billing challenges related to this transition?

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