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In the United States, Medicaid is a government program that provides health insurance for adults and children with limited income and resources. The program is partially funded and primarily managed by state governments, which also have wide latitude in determining eligibility and benefits, but the federal government sets baseline standards for state Medicaid programs and provides a ...
The Texas Health and Human Services Commission (HHSC) is an agency within the Texas Health and Human Services System. It was established by House Bill 2292 in 2003 during the 78th Legislature, [ 1 ] which consolidated twelve different healthcare agencies into five entities under the oversight of HHSC.
A National Provider Identifier (NPI) is a unique 10-digit identification number issued to health care providers in the United States by the Centers for Medicare and Medicaid Services (CMS). The NPI has replaced the Unique Physician Identification Number (UPIN) as the required identifier for Medicare services, and is used by other payers ...
Primary Care Case Management (PCCM) is a system of managed care in the US used by state Medicaid agencies, in which a primary care provider is responsible for approving and monitoring the care of enrolled Medicaid beneficiaries, typically for a small monthly case management fee in addition to fee-for-service reimbursement for treatment. [1]
Conflicting information, computer systems not working, denials before verification and more problems come to the surface from whistleblowers, advocacy groups.
In the 1980s, as Medicaid managed care expanded across the county, safety net providers, such as Community Health Centers (CHCs) and public hospitals, feared that managed care would reduce reimbursements for Medicaid-eligible services, making it more difficult for them to provide care to the un- and under-insured, and result in a loss of Medicaid volume, as beneficiaries would choose to see ...
A variety of different types of health plans serve Medicaid managed care programs, including for-profit and not-for-profit, Medicaid-focused and commercial, independent and owned by health care providers such as community health centers. In 2007, 350 health plans offered Medicaid coverage.
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