Quick recap

This meeting focused on billing and reimbursement challenges faced by substance use disorder treatment providers. Ivonne explained that HHSC audits have identified unallowable expenses where staff salaries for maintenance and repairs weren't properly justified in the budget, leading to denied claims. The group discussed issues with United Healthcare and other managed care organizations (MCOs) not paying the correct rates after Medicaid rate changes on March 1st, with Kathy reporting that United Healthcare only paid the lower group rate instead of the higher individual rate. Providers shared concerns about declining MCO responsiveness and support, with Lucy noting that MCOs are less attentive to providers' needs compared to earlier when they had regular meetings and better communication. The discussion also covered challenges with assessment-only charges being denied due to prior authorization requirements, marketplace insurance grace periods causing authorization issues, and potential opportunities to expand billing codes for substance use disorder…

Quick recap

The meeting focused on billing and financial challenges faced by behavioral health providers, particularly regarding Medicaid Managed Care Organization (MCO) rate reductions and service delivery issues. The group discussed Superior 100's decision to reduce targeted case management (TCM) rates by 40% for most providers, with only three "super providers" in the entire state able to maintain existing rates, affecting approximately 178 clients. Providers shared experiences about the difficulty of predicting service needs and moving funds between service types under current contract structures, with the state expressing concerns about unanticipated shifts from residential to outpatient services. The discussion also covered challenges with billing for patient medications and medical visits, with providers typically absorbing these costs or partnering with pharmacies like Juvenile to help indigent clients. The group explored potential solutions including implementing wraparound rates to make providers whole and allowing payment of patient deductibles, co-payments, and admission fees, while…

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:…

Quick recap

The meeting focused on billing and insurance challenges faced by behavioral health organizations, particularly regarding Medicaid, Medicare, and private insurance claims. Participants discussed issues with Texas Children's Hospital and other providers regarding denial codes, particularly the H0005 billing code, and difficulties in reaching dedicated insurance representatives for claims resolution. The group explored how software updates and AI automation are increasingly affecting claims processing, leading to unexpected denials and payment issues. They also discussed concerns about high insurance deductibles and coinsurance fees preventing patients from accessing necessary treatment, with participants agreeing to raise these issues at the next HHSC meeting. The conversation concluded with a discussion about tracking administrative time spent on billing activities, which could help demonstrate the operational costs associated with insurance claims processing.

Next steps

• Noelle: Consult with Dwayne about strategies and experiences related to Medicaid/Medicare billing and recoupment issues to identify potential solutions or advocacy…

Quick recap

The team discussed logistics for an upcoming meeting and addressed recent communications, including email updates and link issues. They reviewed changes to various programs and grants, expressing concern for affected employees and staff. The conversation ended with discussions on payment delays, grant challenges, and the need for alternative funding sources, with participants encouraged to complete a survey assessing the impact of these grants.

Next steps

• Anna: Continue working on notification settings for the website to reduce mass emails and clarify if users need to adjust settings themselves.

• All group members: Fill out the survey regarding the impact of SAMHSA grant cuts (if not already done), regardless of whether the cuts are rescinded, to help communicate impact to the state.

• Noelle: Update the group with more information after her call with HHSC.

  
  

Quick recap

In a meeting with limited attendance, the group discussed significant funding cuts affecting service providers, particularly Santa Maria's reduced capacity for pregnant and parenting women clients. They explored challenges with contract models shifting to cost reimbursement, requiring detailed expense reporting, and concerns about timely contract execution for fiscal 2026. The discussion also covered difficulties with private insurance enrollment and billing, with Noelle offering to raise these concerns in an upcoming meeting with HHSC, particularly regarding where to refer clients given Santa Maria's reduced bed capacity.

Next steps

• Noelle to ask HHSC in Monday's meeting about where providers should refer clients who can no longer be served due to funding cuts, particularly pregnant and parenting women.

• Noelle to inquire with HHSC about the status of TRF and TRA contracts for fiscal year 2026 and address concerns about the inability to backdate claims if contracts are not executed by September…

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.

Quick recap

The meeting began with personal updates from Carrie about her daughter's surgery and recovery, followed by discussions about meeting logistics and scheduling issues. The team addressed billing challenges related to RSS and PRS contracts, including delays in submitting invoices and processing payments through various systems. The conversation concluded with discussions about credentialing processes and authorization requirements for OTP services, highlighting ongoing challenges with payment processing and Medicaid revalidation.

Next steps

• Carrie to check the REDCap link in the email for submitting September billing for the PRS contract.

• Carrie to prepare for Medicaid revalidation due in April.

• Noelle to reset and streamline meeting invites after the November member meeting.

Quick recap

The team discussed ongoing payment delays from HHSC and Be Well, with Noelle proposing legislative solutions for automatic advances and Barbara highlighting critical impacts on cash flow and payroll. They addressed challenges with Medicaid placements, CMBHS audits, and insurance verification issues, while noting concerns about delayed authorizations and admissions. The conversation ended with updates on upcoming visits and legislative trips, along with discussion of a technical glitch requiring immediate attention.

Next steps

• Noelle: Reach out to Dr. Laguna (and JGC) today to determine the status of HHSC payments and payment glitches, and emphasize the critical cash flow impact on agencies.

• Noelle: Bring up the issue of delayed payments and the suggestion of automatic advances/mandated payment timelines in the legislative group for potential legislative action.

• Luci.Silva: Email Noelle with a detailed explanation of the Medicaid/private insurance authorization issue for forwarding to Dr. Laguna for clarification and possible resolution.

Quick recap

The meeting focused on addressing billing and payment challenges faced by providers under the Be Well and HHSC contracts. Participants discussed delays in receiving payments, with Be Well causing a 30-35 day delay for MOUD services and no payments received for YRC, RSS, and TTOR. Carrie highlighted the extensive process required for submitting invoices and receipts, which she felt was overly burdensome. Noelle explained that Be Well took over the work previously done by HHSC and suggested that the extra requirements were likely meant to protect Be Well in case of audits. The group also touched on challenges with CCMS reporting and the upcoming changes to how program income reports would be handled. The conversation ended with a brief discussion about holiday plans and a sharing of innovative programming initiatives at residential treatment facilities.

Next steps

• Noelle: Set up a meeting with Be Well and HHSC to discuss ongoing…