Welcome to your daily briefing on healthcare developments in Texas. Today we're covering 9 key stories including updates on texas healthcare headlines, texas healthcare updates, background & context. Let's dive in.
5 stories
Explore the Health Data Research and Reports we’ve compiled. Find data on Health Care Facility Reports, community-level health information and more.
Relevant to healthcare professionals operating in TX.
Custom Reports from All Payor Texas Hospital and Ambulatory Surgery Center Data.
Relevant to healthcare professionals operating in TX.
This page provides information aboutTexas Health Care Information Collection (THCIC).
Relevant to healthcare professionals operating in TX.
Learn more about the Facility Reporting Requirements, so health professionals in the state of Texas can obtain the data needed to improve the health of Texans.
Relevant to healthcare professionals operating in TX.
Moratoria Provider Services and Utilization Data Tool(Updated from February 22, 2016)Â.
Relevant to healthcare professionals operating in TX.
Reach healthcare professionals
1 story
The Look Up a License tool allows you to search license and permit information, including physician profiles and verification details for healthcare professionals licensed by the State of Texas. This includes: PhysiciansPhysician….
Relevant to healthcare professionals operating in TX.
3 stories
Across most payors, the top-five denial reasons account for over 80% of prior-auth rejections: missing clinical documentation, wrong CPT/HCPCS code, service not in benefit plan, step-therapy not completed, and ordering provider not on the patient's plan. The same five repeat across plans because they are the easiest to deny on automation.
Practices that build a five-line pre-submission checklist around these reasons typically cut prior-auth denials by 40-60% within a quarter. The fix is process, not appeals capacity.
Three application defects routinely delay payor enrollment: incomplete work-history explanations for any gap over 30 days, a malpractice carrier-history that does not reconcile with the explanation, and CAQH attestation that has lapsed. Each forces a back-and-forth with the credentialing committee.
A new clinician without active payor enrollment cannot bill for covered services for most plans. Each month of delay is foregone revenue that does not retroactively recover.
A vendor is a business associate if they create, receive, maintain, or transmit PHI on behalf of the covered entity. They are NOT a business associate just because they happen to be in a building with PHI or could conceivably access it. The functional test matters, not the proximity test.
Forcing BAA execution on vendors who do not meet the functional test creates contractual bloat and weakens the negotiating position with vendors who actually do. Failing to execute BAAs with true business associates exposes the covered entity to OCR enforcement.
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