Texas Medicaid Encounters Report

Owned by Dylan Nigh
Apr 28, 2023
2 min read

Note: This report may still help with meeting MIPS requirements, but is likely out of date. 

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The Texas Medicaid report calculates the percentage of patient encounters that are considered as an encounter with a Medicaid Patient, as per the state of Texas' guidelines.

The definitions and requirements for this report were specifically written to meet Texas' standards, though these could be the same for a number of other states.

The report can be filtered by Providers, Offices, and Office Visit Start and End Dates.

This report will separate encounters into three categories-

  • Medicaid - Encounters will display in this group if the charges were billed to Medicaid. This will include encounters on claims that have been paid and closed and those that have been billed but are not yet paid.

  • Non-Billed Medicaid - Encounters will display in this group if the charges were not billed to Medicaid, but the patient had active Medicaid insurance on file at the time of their encounter. To be sure that this is valid insurance even though it may not be billed, MacPractice checks for the Plan Type of Medicaid, a Start Date on the insurance before the date of the encounter, and for the Subscriber ID to be filled in.

  • NOT Medicaid - Encounters will display in this group if they don't belong in the other two. This will include all encounters that were never billed to Medicaid and have no indication that the patient currently held Medicaid insurance at the time of their encounter.

All categories display the following columns:

  • # of Encounters: This is the number of Encounters in which transactions occurred.

  • % of Encounters: This is the percentage of the total number of Encounters during the filtered dates that are either NOT Medicaid, Medicaid Non-Billed, or Medicaid encounters.

Click the disclosure triangle on any group to display each patient encounter counted within the group. Each group includes the following columns:

  • Patient #: the Patient ability.

  • Patient Name: The First Name and Last Name of the patient.

  • Insurance Company: The name of the patient's primary Insurance company that was billed. This will display "No Insurance" if the patient does not have any insurance or if no insurance company was billed for that date of service.

  • Date Of Service: The Procedure Date of the encounter.

  • Primary Diagnosis: The first diagnosis code entered onto the charge.

  • Claim Status: The current status of the claim (if there is one) for that encounter.

  • EOB Reason Codes: Any reason codes entered for that charge from the insurance payment window.

  • Provider Name/NPI: The First Name and Last Name of the provider on the charge as well as their NPI (pulled from their User reference and/or the Office reference.

  • TINs: These will pull from the Federal and SSN numbers from the provider's User Reference and the Federal Tax ID form the Office reference.

  • Office/Provider: The Office ID and the Provider User ID listed on the charge made for the encounter.

  • Insurance Provider IDs: This will display the paper and electronic IDs of the provider on the charge.

You can also Export the results for this report.