Texas Medicaid Will Post Updated Off-Cycle Fee Schedule on June 16, 2025

Jun 18, 2025

1 minute

Texas Medicaid Will Post Updated Off-Cycle Fee Schedule on June 16, 2025

Note: A Texas Medicaid managed care organization (MCO) shall provide any medically necessary and Medicaid-covered services to the members who have enrolled in their MCO. Administrative procedures such as prior authorization, precertification, referrals, as well as claiming and filing of encounter data, may be very different not only from traditional Medicaid (fee-for-service) but from one MCO to another. Providers must, therefore, contact the particular MCO of the member for further details.

The Texas Medicaid & Healthcare Partnership (TMHP) discovered a problem with the static fee schedule update processed on April 15, 2025, where the Clinical Laboratory static fee schedule (PRCR494C) contained duplicate entries. TMHP has corrected the issue and will issue an off-cycle static fee schedule on June 16, 2025, including the revised Clinical Laboratory static fee schedule.

For additional details, contact the TMHP Contact Center at 800-925-9126.

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Credentialing

Credentialing is the rigorous process of verifying a healthcare provider’s qualifications, including their education, training, licenses, and clinical experience. This service ensures that practitioners meet the high standards required by insurance networks and hospitals to provide care and receive reimbursement.

Billing & Collection

Billing and Collection service involves confirming a patient’s insurance coverage, active status, and specific benefits before their appointment. By identifying co-pays, deductibles, and required prior authorizations upfront, staff can prevent claim denials and help patients understand their financial responsibilities.

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Eligibility verification is the process of verifying a patient’s health insurance coverage and benefits to determine what services are covered and the level of coverage available. This process is essential for healthcare providers to ensure that they receive proper reimbursement for services rendered and that patients are not left with unexpected medical bills.

Revenue Cycle Management

RCM is the financial process that manages the entire lifecycle of a patient’s account, from the initial appointment scheduling to the final balance payment. It integrates eligibility, coding, billing, and collections into a single, cohesive workflow aimed at maximizing a practice's profitability.

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