Medical billing services in Texas
Texas practices bill into one of the most varied payer environments in the country. A single clinic may see traditional Medicare patients, Medicare Advantage members, several STAR managed care organizations and a long list of commercial plans in the same week, each with its own portal, authorization rules and fee schedule.
We work with Texas providers remotely, from solo practices in growing suburbs to multi-location groups along the I-35 corridor and the Gulf Coast. Our team works inside your existing EHR or practice management system, keeps track of the details each Texas payer expects and gives you a dedicated account manager who understands how billing works here.
TX
Practices we support in
- Houston
- Dallas–Fort Worth
- San Antonio
- Austin
- El Paso
And everywhere else in Texas. We work fully remotely.
The Texas billing landscape
What makes billing here different, and what we keep an eye on for you.
Medicare through Novitas Solutions
Novitas Solutions is the Medicare Administrative Contractor for Texas, which sits in Jurisdiction H. We follow Novitas billing guidance and local coverage determinations, and use its provider portal for eligibility and claim status.
Texas Medicaid, TMHP and STAR programs
Texas Medicaid is administered through the Texas Medicaid & Healthcare Partnership (TMHP), while most members are enrolled in managed care through STAR, STAR+PLUS, STAR Kids and related programs. Each MCO has its own credentialing, authorization and claims requirements, so we track them plan by plan. Program rules change, so we verify current requirements with HHSC and each plan.
A broad commercial market
Blue Cross and Blue Shield of Texas holds a large share of the commercial market, alongside national carriers and a sizable Medicare Advantage presence. Many plans require prior authorization for imaging, procedures and specialty drugs, which makes front-end verification especially important.
Workers’ compensation and prompt-pay rules
Texas workers’ compensation claims follow rules and fee guidelines set by the Texas Department of Insurance, Division of Workers’ Compensation, which differ from health insurance billing. State prompt-pay rules also set deadlines for clean claims on state-regulated plans. We keep these requirements in view and confirm current rules before relying on them.
Payer programs, contractors and plan lists change. We verify current requirements before we bill.
Our services in Texas
Billing in Texas: common questions
A free revenue audit for your Texas practice
See where claims are stalling with your payers, and what we’d change first.