Texas agencies
Give case management, quality review, and billing staff a clear handoff. One Care Portal helps Texas Medicaid agencies organize service notes and authorizations, review supporting records, and track claims that need follow-up.
Provider quick reference
For STAR+PLUS, including its home and community-based services (HCBS) waiver, service coordination runs through the member’s health plan. For services administered by that plan, follow its authorization and claims instructions. Confirm the responsible payer for the service before filing. Texas HHS service coordination overview, TMHP claims filing instructions.
Use the current Texas Medicaid Provider Procedures Manual for fee-for-service claims filing and prior authorization instructions. Its individual handbooks cover service-specific documentation, including the behavioral health chapter for mental health targeted case management. Texas Medicaid Provider Procedures Manual.
Internal workflow example. Before handing a claim to billing, record which payer administers the service, the applicable authorization reference if required, and the manual or payer instructions the reviewer used.
For behavioral health teams, the Texas mental health TCM documentation review guide walks through pre-billing review for that specific Medicaid service.
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Use the modules together or start with the workflow your agency needs most.
Keep contact notes, plans, and service authorizations in the participant record. Supervisors can see what’s ready for review and return notes that need more detail.
Check readable PDF notes and supporting records against criteria your agency sets for the program and payer. Reviewers inspect flags and record their decisions before the billing handoff.
Validate and submit claims through supported clearinghouse workflows. Track status, work denials, and post 835 electronic remittances to see what was paid.
Yes. Keep your EHR as the system of record and upload readable PDFs to standalone Compliance Review. Automated imports depend on compatible EHR API access and are configured during onboarding.
Claim submission uses supported clearinghouse workflows. We confirm payer, plan, enrollment, transaction, and claim-type fit during setup. Bring examples of the claim types you need to submit.
Bring a blank service-note template and the list of checks your team makes before billing. We’ll show how a supervisor reviews the record and how billing staff track what happens after submission. Contact us.
Keep participant names, records, and other protected health information out of public contact and booking forms.
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