Medicare-to-Medicaid crossover claims
Medicaid Revenue Support
Medicaid Billing Services
Medicaid billing that handles the state rules, MCO requirements, and timely filing traps your team shouldn’t have to chase. Built-in denial prevention services so your claims pay the first time and your staff stays with patients.
Our Services
Comprehensive Medicaid Billing Services Built for U.S. Providers
Revix MD is a specialized Medicaid billing company supporting clinics, group practices, behavioral health organizations, dental providers, outpatient centers, DME suppliers and other specialty providers across the United States.
Each state sets its own eligibility criteria, fee schedules and enrollment requirements, creating ongoing challenges for multi-state and border-area practices… Our team stays up to date on these variations to ensure your claims remain compliant and are reimbursed without delays backed by real-time eligibility checks that confirm coverage before care is delivered.
We also navigate both Fee-for-Service (FFS) and Medicaid managed care billing. FFS follows direct state guidelines, while managed care introduces layered payer contracts, unique prior authorization protocols and plan-specific edits. Our team specializes in both to protect your reimbursements regardless of the reimbursement structure.
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 solutions help 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 & Complex Medicaid Billing Expertise
Dual-eligible patients – those covered by both Medicare and Medicaid present some of the most complex and high-value billing scenarios. Revix MD specializes in dual eligible billing services, ensuring accurate coordination of benefits, proper crossover claim submission and complete reimbursement across both programs.
We also manage:
This level of precision prevents revenue leakage and significantly improves collections for high-risk patient populations.
State Expertise
State Medicaid & Managed Care Expertise
State Medicaid billing differences demand localized knowledge. Reimbursement methodologies, covered services and documentation standards vary significantly across regions.
TMHP (Texas)IHCP (Indiana)Medi-Cal (California)eMedNY (New York)
Our team works directly with major state systems and MMIS portals, including TMHP (Texas Medicaid), IHCP (Indiana), Medi-Cal (California) and eMedNY (New York), ensuring claims are submitted correctly within each state’s infrastructure.
Medicaid managed care billing adds another layer, with multiple MCOs requiring separate credentialing, contracting and utilization management processes… We apply the correct edits and workflows for each payer, reducing rejections and accelerating adjudication.
Medicaid Eligibility, Redetermination & Retroactive Billing
Eligibility instability has become a major revenue risk following Medicaid redetermination changes. Coverage gaps, delayed updates and retroactive eligibility create frequent billing disruptions.
Revix MD actively manages Medicaid redetermination billing challenges, including:
This ensures your practice captures revenue that would otherwise be missed due to eligibility volatility.
Specialized Programs
EPSDT & Specialized Medicaid Billing Services
We support EPSDT billing services (Early and Periodic Screening, Diagnostic and Treatment). A mandatory Medicaid benefit for patients under 21 that is often underutilized or incorrectly billed.
Our team ensures accurate documentation, coding and claim submission for EPSDT services. This helps practices receive proper reimbursement for preventive and early intervention care.
We also support:
Compliance & Results
Certified Compliance, Audit Protection & RAC Defense
Medicaid audits are rigorous and our processes are designed to withstand scrutiny. Our certified coders follow current ICD-10, CPT and HCPCS guidelines to ensure accuracy across all specialties.
We also provide Medicaid RAC audit defense, protecting your practice from recoupments through:
Documentation Validation
Our documentation and coding solutions 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.
Getting Started
15-Day Medicaid Billing Onboarding Timeline
Day 1-3
Access, Credentialing & Payer Review
Credentialing review, system access setup, payer enrollment validation
Day 4-6
EHR, Clearinghouse & Portal Integration
EHR and clearinghouse integration, workflow mapping, staff coordination
Day 7-10
Claim Audit & Denial Trend Review
Claim audit, denial trend analysis and process optimization
Day 11-15
Go-Live & Performance Tracking
Full transition with live claim submission and performance tracking
Secure Your Medicaid Revenue Today
Schedule your free consultation and discover hidden revenue opportunities in your Medicaid billing workflow.
Frequently Asked Questions
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.