Related Stories

Are You Eligible for “Expedited Credentialing?” - 09/23/2020

If you’re completing health plan credentialing, “expedited credentialing” might apply to you. And if it applies, that could be good for you and your practice. But how do you know if it does?

Physicians Needed for Medicaid Managed Care Advisory Panel - 03/03/2020

March 13 is the new deadline to get your application to the Texas Health and Human Services Commission if you want to serve on its State Medicaid Managed Care Advisory Committee. The panel advises the commission on Medicaid managed care operations statewide.

Make Medicaid Managed Care More Efficient - 04/09/2019

HB 4178 is the culmination of work by physicians, hospitals, and health plans to reduce Medicaid red tape. Physicians feel heavily burdened not only by the number of prior authorizations they must complete but also the complexity of the process. The system must be reformed to make it more accountable, transparent, and simpler.

Medicaid Eligibility Verification Website to Be Shuttered Friday - 12/13/2018

The Texas Health and Human Services Commission (HHSC) will decommission the website and the Medicaid eligibility verification Interactive Voice Response system at 7 pm (Central) on Friday.

Summit Seeks Medicaid Improvements - 10/22/2018

Physicians, hospital administrators, and health plan executives gathered at the Texas Medical Association building last week in search of common ground to improve the state’s Medicaid system.

Capitol Matters: TMA Weighs in on Medicaid MCO's, Telemedicine Before Texas Legislature - 09/20/2018

Committees in both chambers of the Texas Legislature are studying complex issues throughout this year to prepare for the next legislative session in 2019. As the year progresses, we’re periodically looking at the health care related issues

Medicaid Is Vital; Let’s Improve the Medicaid Managed Care Program - 08/29/2018

Texas’ Medicaid managed care system faces grave but surmountable challenges that must be addressed with all due haste, beginning with enhanced scrutiny not only of the health plans but also of how the state’s own actions, including deep funding cuts and insufficient agency staff, jeopardize Medicaid’s ability to care for the neediest among us.

Working the Capitol - 08/01/2018

TMA weighs in on opioids, Medicaid, cost transparency.

Pediatricians Offer Five Solutions to Improve Medicaid Managed Care - 06/28/2018

Pediatricians continuously encounter instances of managed care plans placing road blocks — some warranted, many not — between the pediatrician’s recommendations for care and the child receiving that care. These battles are now a way of life in every pediatrician’s office. We must find a way — in the best interest of our children accessing needed care — to create a lasting solution.

Medicaid Managed Care Needs Better Oversight, Networks, Care Coordination, and Physician Payment - 06/28/2018

Texas’ Medicaid managed care system faces grave but surmountable challenges that must be addressed with all due haste, beginning with enhanced scrutiny not only of the health plans but also of how the state’s own actions, including deep funding cuts and insufficient agency staff, jeopardize Medicaid’s ability to care for the neediest among us. At the same time, we must recognize not all Medicaid MCOs are created equal. Some are quite clearly poor performers while others go above and beyond what the state asks of them to ensure their enrollees receive the care they need, including expanding availability of specialty services and improving maternal health outcomes. Texas must learn from and replicate the best practices of the highest- performing plans rather than just punishing the bad apples.

No Progress in Hearing on Medicaid Managed Care Organizations - 06/22/2018

On Wednesday, the Texas House Human Services Committee held the first in what will undoubtedly be a series of hearings on the issues with Medicaid managed care organizations. The buck apparently stopped nowhere.

Modernize Medicaid MCOs with Value-Based Payment Initiatives - 05/17/2018

As managed care has proliferated, so too has the amount of red tape. Texas has multiple health plans for each product type — STAR, STAR+PLUS, and so forth. Physicians who contract with multiple Medicaid MCO plans must contend with different PA requirements for each, though such red tape brings no concomitant increase in quality. Most prior authorization requests are ultimately approved, so imposing them only increases physician overhead while delaying care.

Driving Quality - 04/19/2018

Private payers aren't the only ones eyeing quality-based payment reform to control costs while improving patients' health. Now that Texas Medicaid has moved into managed care almost completely, the state is intent on similar strategies. The Texas Health and Human Services Commission won a $3 million federal grant to design innovative delivery and payment systems. It hopes to win as much as $50 million to later test the models under the Centers for Medicare & Medicaid Services State Innovation Models initiative. From accountable care organizations and medical homes to health information technology and bundled payments, the state is looking to physicians, health plans, and others to figure out what it takes to successfully implement such models for Medicaid patients across the multiple payers and providers that manage them.

Though Far from Perfect, Medicaid Matters to Patients - 04/06/2018

Medicaid Managed Care Quality and Compliance

Medicaid HMO Credentialing – and Recredentialing – Just Got Easier - 04/03/2018

Starting this week, Texas physicians can save time getting credentialed and recredentialed for Texas' 19 Medicaid managed care plans.

Medicaid Credentialing Made Simple - 01/10/2018

A new partnership by the Texas Medical Association and the Texas Association of Health Plans will soon streamline the process of getting credentialed ― and recredentialed ― for Medicaid health plans.

New Guidance on Medicaid Prior Authorizations Related to Harvey Issued - 09/18/2017

The Texas Health and Human Services Commission (HHSC) has released new information and guidance on Medicaid prior authorizations as well as temporary electronic visit verification policies for physicians and other health care providers affected by Hurricane Harvey.

TDI Proposes HMO Rule Rewrite - 12/01/2016

Whenever a state agency undertakes a wholesale overhaul of a set of regulations important to physicians and patients, TMA examines the proposal extremely carefully. That's why a TMA staff team spent weeks studying the Texas Department of Insurance's (TDI's) Oct. 7 proposed repeal and rewrite of the entire regulatory chapter on HMOs.

Embittered Backlog - 11/01/2016

The Texas Medical Association Payment Advocacy Department has received complaints from several physicians that three of the state's biggest health plans are taking up to eight months to credential them. Without successful credentialing, physician payment for medical services can be delayed and even denied.

Nationwide Credentialing - 10/20/2016

Credentialing with the government and health insurance companies continues to be a complex and time-consuming for practices of all sizes. At Nationwide Credentialing, we work with you from start to finish on the credentialing process, which allows physicians and their staff to focus on patients and other important aspects of their practice.

Coming Soon: Credentialing Help From TMA - 06/23/2016

Concerns among physician members about the burden of credentialing and enrollment with hospitals and health plans have prompted TMA to take action. TMA is evaluating credentialing verification organizations that will assist physicians with the credentialing, verification, and enrollment process. TMA wants to affiliate with a company that streamlines the flow of information to all plans operating in Texas, including Medicaid HMOs and hospitals. Stay tuned for the launch of this service, which aligns with TMA's work on network adequacy and the need for health plans to maintain accurate provider directories.

TMA PracticeEdge Moving Forward With Five ACOs, CCM, GPO - 06/23/2016

After review from its Board of Managers, TMA PracticeEdge now has plans to help five groups of TMA physicians implement accountable care organizations (ACOs). In addition to two previously announced ACO projects in Houston and Central Texas, TMA PracticeEdge is poised to move ahead with three more. The five projects include more than 170 physicians and cover 26,000 patient lives.

Simplify Medicaid HMO Administrative Requirements - 05/20/2016

HB2731 would help standardize and streamline Medicaid HMO administrative requirements. Standardization will make it easier for my practice to participate in Medicaid, while also lowering my practice costs. Medicaid is the lowest payer in most physician practices, so any reduction in administrative costs is essential to enhancing physician Medicaid participation.

Medicaid Roadblocks - 05/13/2016

It's caused problems for physicians and their patients, but Medicaid managed care is here to stay. State officials are committed to it to reduce costs in a growing program that consumes a quarter of the state budget. Still, some physicians are not convinced Texas Medicaid is better off under managed care.

Fill Out Every Section of Medicare CMS-855 Forms - 05/13/2016

Fill Out Every Section of Medicare CMS-855 Forms