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News update

Jul 23, 2025

Texas Medicaid Implements Medication and Prior Authorization Updates

Yorvipath will require new prior authorization procedures, which will start on September 1, 2025, and Zoryve will have an additional check on plaque psoriasis included in clinical criteria.

It is advised that providers take another look at the updated criteria and make sure that they comply by the effective date.

The official documentation can be used to have full details

In case of questions or further help, you can chat on UnitedHealthcare Provider Portal.

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Credentialing is the rigorous process of verifying a healthcare provider’s qualifications, including their education, training, licenses, and clinical experience. This service ensures that practitioners meet the high standards required by insurance networks and hospitals to provide care and receive reimbursement.

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Billing and Collection service involves confirming a patient’s insurance coverage, active status, and specific benefits before their appointment. By identifying co-pays, deductibles, and required prior authorizations upfront, staff can prevent claim denials and help patients understand their financial responsibilities.

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Eligibility verification is the process of verifying a patient’s health insurance coverage and benefits to determine what services are covered and the level of coverage available. This process is essential for healthcare providers to ensure that they receive proper reimbursement for services rendered and that patients are not left with unexpected medical bills.

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RCM is the financial process that manages the entire lifecycle of a patient’s account, from the initial appointment scheduling to the final balance payment. It integrates eligibility, coding, billing, and collections into a single, cohesive workflow aimed at maximizing a practice's profitability.

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