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and a letter stating credentialing was valid through 2028, and raised concerns about alignment of cycles and possible outdated information.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 was briefly discussed. The conversation ended with a reminder about using the ASAP website for ongoing group communication.

Next steps

Carrie

• Contact Verity (Versi) to inquire about the re-credentialing notice and verify if their information is outdated.https://tasks.zoom.us?meetingId=edPIfSkmQLa7OCD2qS6dDA%3D%3D&stepId=fa2663bc-9cb0-11f1-9884-ae07ad757cfe

• Wait for a response from Mrs. Alexis Dimes (manager at Texas Children's) regarding the re-credentialing issue and the CVO date alignment.https://tasks.zoom.us?meetingId=edPIfSkmQLa7OCD2qS6dDA%3D%3D&stepId=fa266c26-9cb0-11f1-af76-ae07ad757cfe

• File a provider complaint with UnitedHealthcare regarding the underpayment of code H0004, if necessary.https://tasks.zoom.us?meetingId=edPIfSkmQLa7OCD2qS6dDA%3D%3D&stepId=fa267015-9cb0-11f1-95d2-ae07ad757cfe

• Explore options for a new billing company to replace Athena.https://tasks.zoom.us?meetingId=edPIfSkmQLa7OCD2qS6dDA%3D%3D&stepId=fa267723-9cb0-11f1-b2f1-ae07ad757cfe

LUCI

• Provide Anunoy with a list of EHRs that integrate with CMBHS.https://tasks.zoom.us?meetingId=edPIfSkmQLa7OCD2qS6dDA%3D%3D&stepId=fa26739e-9cb0-11f1-9dd9-ae07ad757cfe

Noelle

• Continue to build a relationship with the association for MCOs to address communication breakdowns.https://tasks.zoom.us?meetingId=edPIfSkmQLa7OCD2qS6dDA%3D%3D&stepId=fa267a84-9cb0-11f1-aae6-ae07ad757cfe

Collaboration

• ASAP members: Consider contributing data on credentialing cycles and inefficiencies for potential legislative advocacy.https://tasks.zoom.us?meetingId=edPIfSkmQLa7OCD2qS6dDA%3D%3D&stepId=fa267e2c-9cb0-11f1-ba3e-ae07ad757cfe

Summary

Healing Through Handmade Art Program

Carrie shared details about her "Healing Through Handmade" program, which brings art classes to clients through Zoom, featuring activities like painting with a twist and jewelry making. She described a successful recent session where an artist from Florida guided participants through a painting activity, providing well-prepared kits with canvases, paints, and brushes. Ivonne shared her own positive experience using art therapy with clients during her practice as a therapist, confirming the effectiveness of art-based interventions.

Texas Children's Network Re-credentialing Update

Carrie explained that Texas Children's had re-credentialed their orange location through a company called Versi, which handles provider re-credentialing in Texas for managed care organizations. She revealed that after previously submitting re-credentialing paperwork in 2022, the process had remained incomplete when the person handling it quit, leading to the organization being kicked out of network and resulting in approximately $20,000 in denied claims. Carrie noted that following a state complaint filed with HHSC, Texas Children's agreed to reinstate them and reverse the claim denials, potentially covering around $60,000 in unpaid claims.

CVO Re-credentialing Process Update

Carrie explained that despite completing re-credentialing and site visits last year, she received a notice in April asking to re-credential one of their locations, with a deadline of end of day Tuesday. She discovered that Texas Children participates in a state-mandated CVO (Credentialing Verification Organization) program, and Versi serves as the CVO that requires alignment with state re-credentialing cycles. Carrie submitted the required documentation to the head of contracting, Mrs. Alexis Dimes, questioning why the previous year's re-credentialing process was not sufficient to maintain alignment through 2028.

Credentialing and Payment Concerns

Carrie expressed concerns about Veracy only wanting to re-credential one location instead of all three, which she believes could disrupt the intended credentialing cycle and may indicate outdated information. She submitted questions about CBO dates and credentialing effectiveness through 2028 but has not received a response yet. Carrie also mentioned plans to file provider complaints regarding UnitedHealthcare's underpayment of the H0004 code at the lower Medicaid rate, as they continue to pay based on submitted claim amounts rather than updated rates.

MCO Credentialing and Portal Issues

Carrie discussed plans to contact Verity directly to investigate discrepancies in information they provided to Texas Children's, before filing additional provider complaints. The group discussed challenges with MCO credentialing processes, with Carrie noting that while applications are standardized, MCOs don't appear to be processing them simultaneously as intended by the state mandate. The discussion also covered issues with Availity portal functionality, with participants sharing experiences of inconsistent information and user-friendly problems when processing authorizations. The conversation ended with a discussion about billing software alternatives to Athena, with Lucy mentioning their use of Metasoft and offering to share information about EHRs that integrate with CMBHS.