Medicare-to-Medicaid crossover claim support
Medicaid Revenue Support
Medicaid Billing Services
Revix MD provides Medicaid billing services for healthcare providers that need cleaner claims, fewer denials, and faster reimbursement. From eligibility verification and claim preparation to payer-specific edits, denial management, and payment follow-up, we help protect your Medicaid revenue while your team stays focused on patient care.
Our Services
Comprehensive Medicaid Billing Services
Built for U.S. Providers
Revix MD is a Medicaid billing company built for clinics, group practices, behavioral health organizations, dental providers, outpatient centers, DME suppliers, and specialty providers across the United States. Because Medicaid rules vary by state, payer, program, and managed care plan, our team supports Medicaid claims processing, eligibility checks, claim scrubbing, authorization workflows, denial follow-up, and reimbursement tracking with greater accuracy.
Medicaid Eligibility VerificationPayer-Specific Claim Scrubbing
State Medicaid & MCO Rule Tracking
Transparent Revenue Performance Reporting
State Medicaid & MCO Rule Tracking
Transparent Revenue Performance Reporting
Medicaid Eligibility Verification Before Claims Are Submitted
We verify Medicaid eligibility, coverage status, plan details, authorization requirements, and patient responsibility before services are billed. This front-end process helps prevent avoidable denials caused by inactive coverage, missing authorizations, incorrect payer details, or benefit limitations.
We track authorization timelines based on applicable Medicaid, state, and managed care plan requirements to reduce preventable delays and front-end denials.
Medicaid Claims Processing, Denial Management & A/R Follow-Up
Our Medicaid claims processing workflow helps prepare, scrub, submit, and track claims according to payer-specific rules. When denials occur, we review root causes, correct issues, resubmit claims, and follow up on unpaid or underpaid balances until the claim reaches resolution.
Complex Billing
Dual-Eligible Medicare and Medicaid Billing Support
Dual-eligible patients — those covered by both Medicare and Medicaid — often create complex billing scenarios involving coordination of benefits, crossover claims, secondary billing, and payer-specific payment rules. Revix MD helps providers manage dual-eligible billing with accurate claim sequencing, Medicare-to-Medicaid crossover support, payment reconciliation, and follow-up across both programs.
State Expertise
State Medicaid Billing Rule Tracking
State Medicaid billing requires localized knowledge because eligibility rules, fee schedules, claim formats, portals, prior authorization requirements, and managed care workflows can vary by state. Revix MD supports providers working with state Medicaid systems, MMIS portals, and Medicaid Managed Care Organizations so claims are routed, reviewed, and followed up correctly.
TMHP (Texas)IHCP (Indiana)Medi-Cal (California)eMedNY (New York)
We help providers manage state-specific claim rules, portal workflows, payer edits, authorization requirements, and follow-up processes.
Medicaid Eligibility, Redetermination & Retroactive Billing
Medicaid eligibility changes, redetermination issues, and retroactive coverage updates can quickly create claim delays, denials, and missed reimbursement opportunities. Revix MD monitors eligibility status, identifies coverage gaps before claim submission, and supports retroactive Medicaid billing when coverage is updated after the date of service.
Specialized Programs
EPSDT & Specialized Medicaid Billing Services
Revix MD also supports EPSDT billing services for Medicaid-covered patients under 21. Our team reviews documentation, coding, payer rules, and claim requirements to help providers bill preventive, diagnostic, and treatment services accurately.
We also support:
Compliance & Results
Medicaid Compliance, Documentation
Review & Audit Support
Medicaid audits are rigorous and our processes are designed to withstand scrutiny. Our certified coders follow current ICD-10, CPT and HCPCS guidelines. We also provide Medicaid RAC audit defense. Our billing team follows current ICD-10, CPT, HCPCS, payer documentation, and Medicaid billing requirements to reduce compliance risk and support audit-ready claims.
Documentation Validation
Our documentation and coding review helps check ICD-10, CPT, HCPCS, medical necessity, and payer-specific requirements before Medicaid claims are submitted.
Pre-Audit Risk Identification
We identify billing patterns, documentation gaps, and denial trends that may create audit exposure.
Appeal & Audit Response
We help organize claim details, documentation, appeal packets, and payer communication for Medicaid audit and denial reviews.
Integration & Clearinghouses
Connects with Availity, Change Healthcare and MMIS portals for accurate claim routing and faster adjudication.
Medicaid Billing Performance Benchmarks
Metric
Industry Average
Revix MD Performance
First-Pass Clean Claim Rate
85-90%
97.4%
Days in A/R
40-55 days
Reduced by up to 37%
Net Collection Rate
90-93%
Up to 97%
Denial Rate
10%–15%
Less than 5%
Performance outcomes vary based on specialty, payer mix, claim volume, documentation quality, system access, and historical denial trends.
Getting Started
30-Day Medicaid Billing Onboarding Timeline
WEEK 1
Access, Credentialing & Payer Review
System access setup, Medicaid enrollment validation, payer list review, and workflow discovery.
WEEK 2
EHR, Clearinghouse & Portal Integration
EHR access, clearinghouse setup, Medicaid portal access, workflow mapping, and staff coordination.
WEEK 3
Claim Audit & Denial Trend Review
Historical claim review, denial pattern analysis, coding/documentation gap review, and process optimization.
WEEK 4
Go-Live & Performance Tracking
Live claim submission, payment follow-up, denial tracking, A/R monitoring, and reporting setup.
Protect Your Medicaid Revenue Before
Denials Slow You Down
Schedule a free Medicaid billing audit and see where eligibility issues, payer edits, denials, or follow-up gaps may be costing your practice revenue.
FAQs
How do you handle dual-eligible Medicare and Medicaid crossover claims?
We manage full coordination of benefits, ensuring accurate crossover submissions and maximum reimbursement from both programs without duplication or loss.
Can you manage billing during Medicaid redetermination disruptions?
Yes. We track eligibility changes, submit retroactive claims and prevent denials caused by coverage gaps or delayed updates.
Which state Medicaid portals does your team work with?
Our team has experience with major MMIS systems including TMHP, IHCP, Medi-Cal and eMedNY, along with multiple managed care portals.
How do you handle retroactive Medicaid eligibility?
We identify retroactive coverage periods, reprocess claims and recover payments that would otherwise be missed.
What is your Medicaid-specific denial management approach?
We focus on proactive claim accuracy and aggressive follow-up, identifying root causes and overturning denials through structured appeals and payer-specific strategies.
What is included in Medicaid claims processing?
Medicaid claims processing includes eligibility verification, claim preparation, payer-specific claim scrubbing, electronic submission, denial correction, appeals support, payment posting, and A/R follow-up to help providers receive accurate reimbursement.
Do you support Medicaid managed care billing?
Yes. Revix MD supports Medicaid managed care billing by helping providers manage MCO-specific rules, authorization requirements, claim edits, portal follow-up, denial management, and reimbursement tracking.