Lone Star Revenue Cycle Management

06/12/2026

Baylor Scott & White Health Plan (BSWHP) has received regulatory approval to exit the Texas Medicaid Managed Care Program on August 31, 2026, and discontinue Individual Marketplace Plans after December 31, 2026.

Beginning mid-June, we will communicate directly with affected members and provide guidance and support through their transition.

Important to note:
Baylor Scott & White Health Plan/RightCare and FirstCare Health Plans will continue to pay claims for services delivered and covered by Medicaid and Individual Plans through Aug. 31, 2026, and Dec. 31, 2026, respectively.
As the dates above draw near, we encourage you to remind customers and front desk staff to verify coverage to help your patients avoid any unexpected out-of-pocket costs.

05/18/2026

Aetna I have a provider that has been in network for a long time. I sent a LOI to get a specific local network added to his contract. However, I just called to follow up and was told the network couldn’t be added because his TIN is out of network. This is absolutely untrue and unacceptable. Please help.

05/02/2026

02/04/2026

https://natlawreview.com/article/continuing-appropriations-act-2026-another-lifeline-medicare-telehealth?fbclid=IwZnRzaAPvhWNleHRuA2FlbQIxMQBzcnRjBmFwcF9pZAo2NjI4NTY4Mzc5AAEeZn5qxG2wK38ti_sXMAEZkPK0y0dcRGFZxEHoPwhG_K2xChMIyynPeb9xHxY_aem_t38UmcExN3-O5WkW_EXtpw #:~:text=On%20February%203%2C%202026%2C%20President,telehealth%20through%20December%2031%2C%202027

This post was co-authored by Paul Palma, legal intern at Robinson+Cole. Paul is not admitted to practice law.

11/25/2025

FYI

TRICARE Claims Adjustments Under Review

Dear Valued TRICARE West Region Provider,
We are reaching out to inform you of an operational error that affected the processing of certain TRICARE claims that were incorrectly designated as non-network. As a result, some copayments may be impacted, and some claims may have resulted in overpayments.
All impacted claims are currently under review, and when adjustments are made, an updated Remittance Advice will be issued. Please watch for a letter from our claims processor, PGBA, on recoupment of funds and instructions for repayment.
Recoupments begin November 24, and it is estimated the reprocessing period will take 120 days.
What We Know
Over the next 120 days you may receive a notice of a recoupment from PGBA
Recoupment efforts begin November 24
This may impact a beneficiary’s copay and deductible
All impacted claims will be reprocessed
Remittance advices will be regenerated as appropriate
While we do not yet have a final timeline for all corrections, PGBA is working to prioritize accuracy and minimize the burden throughout this process. Details regarding your recoupment will be sent to you from PGBA.
We sincerely apologize for this inconvenience and appreciate your patience and understanding. Thank you for your continued commitment to caring for our nation’s military community.
To check the status of a claim, visit the provider portal on Availity

11/15/2025

Healthcare practitioners who performed telehealth services to Medicare patients on or after Oct. 1 should be on the lookout for returned claims. The CMS is rejecting certain telehealth claims because it cannot identify all instances of behavioral and mental health services.

10/30/2025

Thank you, Jennifer!

★★★★★

10/15/2025

The BCBSTX telehealth “glitch” has been resolved. We will be sending our clients claims back for re-processing.

10/04/2025

⚠️ Medicare Update: Claims & Telehealth ⚠️

***Thank you Shelly Clise***

📌 Claims Hold:

Starting Oct 1, 2025, Medicare is putting a temporary hold (up to 10 business days) on payments while Congress works on funding.

You can still send claims, but payments will be delayed.

📌 Telehealth:

If Congress doesn’t act, many pre-COVID limits return Oct 1, 2025:

Most telehealth won’t be covered outside rural areas or in patient homes.

Hospice recertifications must be done in person.

Some providers such as PT, OT, and SLP, will not be reimbursed for telehealth services since CMS has not permanently added these specialties to the list of approved telehealth providers.

Use an ABN for Traditional Medicare if you keep providing non-covered telehealth.

✅ Bottom line: Expect payment delays and telehealth restrictions unless Congress makes changes.

Update on Medicare Operations: Telehealth, Claims Processing, and Medicare Administrative Contractors Status During the Shutdown

12/31/2024

https://www.foley.com/insights/publications/2024/12/medicare-telehealth-flexibilities-get-a-three-month-lifeline/

After much uncertainty, Congress has extended many Medicare telehealth flexibilities through March 31, 2025, in its end-of-year appropriations bill.