Lone Star Revenue Cycle Management

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.

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

Thank you, Jennifer!

Google review of Lone Star Revenue Cycle Management ★★★★★