Texas Medicaid Health Plans Joined by TMA in Taking Major Step To Make Medicaid Simpler, More Efficient for Texas Physicians

AUSTIN—The Texas Association of Health Plans (TAHP) in collaboration with the Texas Medical Association (TMA) has announced a joint effort to reduce red tape and administrative burdens for physicians and health care providers seeking to participate in the Texas Medicaid program. TAHP and TMA have selected Aperture, LLC, for a statewide Credentialing Verification Organization (CVO) contract used by all 20 Medicaid health plans in Texas to streamline the provider credentialing process.

“To date, managed care health plans have made significant strides in transforming the Texas Medicaid program to deliver dramatically improved care and outcomes for patients and reduce costs for the State and taxpayers,”said Jamie Dudensing, TAHP CEO and a former practicing nurse. “Today’s announced CVO marks a significant step forward in streamlining credentialing and making it much easier for providers to participate in the program and see Texans on Medicaid. Medicaid health plans are proud to have initiated this effort, and we look forward to continuing to work with TMA to establish a one-stop-shop for providers that greatly reduces their paperwork burden, ensures a more seamless process, and boosts access to safe, quality care for Texans who rely on Medicaid program for their health care needs.”

“Countless Texas physicians want to care for Medicaid patients, but the barrier of Medicaid’s bureaucratic red tape and administrative burdens simply discourage them,” said Don R. Read, MD, TMA’s president. “We hope simplifying doctors’ credentialing and re-credentialing process will ease the path for more Texas physicians to see Medicaid patients.”

Aperture’s CEO, Charles Falcone, said, “Aperture’s partnership with the TAHP will bring together all credentialing stakeholders in a compliant, efficient, and consistent manner.” He added, “The Unified Credentialing Program will remove many redundancies and create cost savings in both hard dollars and time compared to legacy methods.”


Medicaid Managed Care: In Texas, private health plans or managed care organizations (MCOs) manage the Medicaid program for the State. The State began transitioning to this approach, called the managed care model, in recent years as an alternative to the former costly and inefficient fee-for-service (FFS) model. The managed care private-market approach drives innovation through flexibility and competition, reduces health care costs, and holds Medicaid health plans accountable for providing access to quality care. It has saved the State and Texas taxpayers $4 billion over a six-year period and is expected to save another $3 billion or more by 2018. Just as important, lives and outcomes are being improved with hospital admissions down 20-to-40% for some of the most common and treatable conditions. A recent study found that access and quality for Texas Medicaid health plan enrollees is better than FFS and comparable to private health coverage.

Provider Credentialing: Through this process, MCOs gather and assess background information on health care providers in an effort to confirm the provider is in good standing, ensure patient safety, and prevent fraud, waste and abuse. As it stands, each MCO gathers this background information from providers separately and with varying deadlines, requiring providers to submit and re-submit their information to all 20 Medicaid health plans individually and at different times.

CVO: Texas Medicaid health plans brainstormed on how to simplify this process for physicians and providers and make Medicaid a more welcoming program for quality providers to participate in and provide care to Texas patients. The health plans proposed a statewide CVO concept, which was endorsed during the 84th Texas Legislature in SB 200, jointly authored by Senators Nelson, Birdwell, Campbell, Hinojosa and Schwertner as well as Representatives Price, Raymond, Dutton, Burkett and Larry Gonzales.  The bill established a vision for Texas to streamline the Medicaid provider credentialing process.

How it Works: Simplification of the credentialing process be achieved in several ways. First, there will be a single source for all credentialing information.  That means that if a physician or provider in an area of the state wishes to participate in the network of several health plans in that area then the provider information need only be collected once and is then shared with all of the plans.  Second, the Texas Medicaid health plans elected to adopt a single re-credentialing date.  That means that when a physician must be re-credentialed, generally a process that occurs every three years, the doctor will be re-credentialed once—for all of the participating plans.  Again, this reduces the Medicaid provider hassle factor.  Dudensing added that she is hopeful health plans will include additional lines of business such as commercial insurance and Medicare to the CVO project to further simplify healthcare administration in Texas.

The project implementation will begin immediately with  statewide operations expected to begin October 2017.

About Texas Association of Health Plans (TAHP)

TAHP is the statewide trade association representing health insurers, health maintenance organizations, and other related healthcare entities operating in Texas.  The association was founded in 1987, and represents the healthcare industry’s commitment to improving healthcare for Texans. Contact Laurie Vanhoose, Director of Policy, Government Programs at www.tahp.org or Lvanhoose@tahp.org.

About TMA

TMA is the largest state medical society in the nation, representing more than 50,000 physician and medical student members. It is located in Austin and has 110 component county medical societies around the state. TMA’s key objective since 1853 is to improve the health of all Texans.

About Aperture Credentialing, LLC

Aperture is the nation’s largest Credentials Verification Organization providing services to some of the largest payer and provider organizations in the country.  Aperture operates nationwide and also manages several other national, state-based and specialty-based unified credentialing programs.  In addition, Aperture’s CredentialSmart software enables provider organizations to manage their end-to-end provider delegation, enrollment, privileging, and credentialing needs. Aperture is NCQA Certified and URAC Accredited for more than 10 years. Contact Michael Moore, SVP Sales, at Mmoore@aperturecvo.com or find more at www.aperturecvo.com.

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