Medical billing services in Texas
Texas practices may bill Medicaid managed care, fee-for-service Medicaid, Medicare, commercial plans and workers’ compensation. We organize the billing work around the patient’s coverage, the service provided and the rules that apply to that claim.
- TXBilled end to end
- 8+Plans commonly billed
- 50+Specialties covered
How coverage changes the Texas billing workflow
These are important areas to check when configuring a Texas billing workflow. The applicable plan and date of service determine the requirements.
- Identify the Medicaid program and plan
STAR, STAR+PLUS, STAR Kids and STAR Health serve different member groups. Check the member’s active plan, service area and billing instructions before routing a claim.
- Workers compensation has its own rulebook
Texas workers’ compensation uses DWC billing and reimbursement rules. Check the date of service, required documentation and any applicable network agreement before calculating the expected payment.
- Border and rural payer mix
A practice in El Paso does not bill the same payer mix as one in Plano. Your account is set up for the plans you actually see, not a statewide average.
Texas Medicaid billing
Fee-for-service Medicaid and managed care have different billing routes.
Identify whether the service is billed to TMHP or the member’s managed care organization. Confirm enrollment, authorization and claim-submission requirements using the applicable manual and plan guidance.
Plans a Texas practice bills
These are plans operating in Texas. Your account is configured for the ones you actually see, not a statewide average. If yours is not listed, ask.
Before a Texas claim is submitted
Configure the work around Texas Medicaid and the plans your practice actually sees.
- Confirm the member plan and billing destination for each date of service.
- Check provider enrollment, service location and authorization requirements.
- Use the applicable filing and appeal deadlines in the claim worklist.
- Reconcile payments against the relevant contract or fee schedule.
For Texas Medicaid, distinguish fee-for-service billing through TMHP from the member’s managed care plan. Workers’ compensation claims require a separate review of DWC billing rules and any applicable network agreement.
Primary references: Texas Medicaid Provider Procedures Manual and Texas DWC medical billing guidance.
Serving practices across Texas
We work remotely inside your practice management system, so where you sit inside the state does not change what we can do. These are simply where Texas practices most often are.
Texas billing questions
Do you bill Texas Medicaid STAR and STAR+PLUS?
Yes, along with STAR Kids and STAR Health. We bill to the managed care organization the patient is enrolled under, which is the part that most often goes wrong.
Do you handle Texas workers compensation claims?
Yes. We review the applicable DWC billing requirements and fee guidelines, including whether a network agreement affects reimbursement. These claims are tracked separately from commercial insurance.
We have clinics in both Houston and Austin. Can you handle both?
Yes. Multi location practices are normal for us. Each location is set up for its own payer mix and its own fee schedule.
What does the free consultation actually involve?
We look at ninety days of your claims data and show you where revenue is stopping, before you commit to anything. If the answer is that your billing is already working, we will tell you that.
Find out what Texas payers owe you
Tell us your specialty and the billing issue you want reviewed. We will agree the scope and arrange a secure way to share any records needed.