From the Texas Medical Center in Houston to the South Texas Medical Center in San Antonio, Texas practices deal with one of the most complex payer mixes in the country: Medicare through Novitas, a Medicaid program that runs almost entirely through managed care plans, and strong commercial carriers led by Blue Cross and Blue Shield of Texas.
How Medical Billing Works in Texas
Every state has its own mix of payers and rules, and Texas is no exception. These are the points that most often decide whether a Texas claim is paid on the first pass:
- Most Texas Medicaid patients are enrolled in managed care, so claims usually go to the patient's STAR or STAR+PLUS plan instead of straight to TMHP — submitting to the wrong payer is one of the most common avoidable denials we fix.
- Texas has several Medicare payment localities (Houston, Dallas, Fort Worth, Austin and others), so the same CPT code can be paid at a different rate depending on where the service was performed.
- Commercial PPO and HMO claims fall under the Texas prompt-pay rules, and we track payment timelines so late or underpaid claims are escalated instead of forgotten.
Our Medical Billing Services in Texas
We run the complete revenue cycle for Texas practices, remotely and inside your existing EHR or practice management system:
- Insurance eligibility and benefits verification before each visit
- Medical coding (CPT, ICD-10-CM, HCPCS and modifiers) by certified coders
- Charge entry and claim scrubbing to catch errors before submission
- Electronic claim submission to Medicare, Texas Medicaid plans and commercial payers
- Denial management and appeals with root-cause tracking
- A/R follow-up on aging claims, worked daily
- Payment posting from ERAs and EOBs, including underpayment checks
- Credentialing and payer enrollment, including TMHP provider enrollment
- Monthly reporting on collections, denials and days in A/R
Who We Work With
Our Texas clients include primary care and internal medicine practices, specialty groups such as clinical billing, pathology billing and ENT billing, independent laboratories and multi-location clinics. Whether you are in Houston, San Antonio or a smaller community, you get the same certified coders, the same daily A/R follow-up and the same transparent reporting.
Cities We Serve in Texas
Specialties We Bill For in Texas
Frequently Asked Questions
Who processes Medicare claims in Texas?
Medicare Part B claims for Texas are processed by Novitas Solutions (Jurisdiction H (JH)). We submit, track and follow up on those claims for you, including Medicare Advantage plans, which are billed to the private plan instead.
How do you bill Texas Medicaid?
Texas Medicaid is run by the Texas Medicaid & Healthcare Partnership (TMHP), and most members are enrolled in STAR, STAR+PLUS, STAR Kids and STAR Health managed care plans. We verify the member's plan before the visit and send each claim to the right plan with the right edits.
Which commercial payers do you work with in Texas?
We bill all major commercial payers in Texas, including Blue Cross and Blue Shield of Texas, UnitedHealthcare, Aetna, Cigna and Humana, plus regional and employer plans.
Which Texas cities do you serve?
We serve practices throughout Texas, with dedicated pages for Houston, San Antonio, Dallas, Austin, Fort Worth, El Paso, Arlington, Corpus Christi, Plano and Lubbock. Because billing is done remotely, practices anywhere in the state can work with us.
How do we get started?
Request a free billing audit. We review a sample of your claims, denials and A/R, show you where revenue is being lost and give you a fixed quote — with no obligation.