Medical Billing Services in Texas
Medical billing for Texas practices — Novitas Medicare, TMHP and STAR managed care plans, and the state’s 95-day filing and prompt-pay rules handled by a team that works Texas claims every day.
Texas Has Its Own Billing Rulebook
Texas practices bill one of the most complex payer mixes in the country: Medicare through Novitas Solutions, Texas Medicaid through TMHP and several STAR managed care programs, a large Medicare Advantage market and major commercial plans such as Blue Cross Blue Shield of Texas, UnitedHealthcare, Aetna, Cigna and Humana.
Texas law also sets its own timelines. For many HMO and PPO plans regulated by the state, physicians generally must file claims within 95 days of the date of service, and plans must pay clean claims within prompt-pay deadlines. Missing the 95-day window can mean losing the claim entirely, which is why we submit and track Texas claims on a daily schedule.
What we handle for Texas practices
- Texas Medicaid fee-for-service claims through TMHP
- STAR, STAR+PLUS, STAR Kids and STAR Health managed care plan billing
- Medicare Part B claims and appeals with Novitas (Jurisdiction H)
- 95-day filing deadline tracking for state-regulated plans
- Prompt-pay monitoring and late-payment follow-up
- Texas Medicaid provider enrollment and revalidation
Texas Payers We Work With
| Payer type | In Texas | What it means for billing |
|---|---|---|
| Medicare Part B | Novitas Solutions, Jurisdiction H | Novitas LCDs and appeal process apply |
| Medicaid fee-for-service | Texas Medicaid, administered by TMHP for HHSC | TMHP enrollment, payer ID and claim rules |
| Medicaid managed care | STAR, STAR+PLUS, STAR Kids, STAR Health and CHIP plans | Each MCO has its own authorization and claim rules |
| Medicare Advantage | Large and growing enrollment statewide | Separate prior authorization and appeal processes |
| Commercial | BCBS of Texas, UnitedHealthcare, Aetna, Cigna, Humana and others | Texas 95-day filing and prompt-pay rules for state-regulated plans |
Payer programs and contractors change over time; we confirm current rules for each claim.
Our Services for Texas Practices
Credentialing
Texas Medicaid enrollment through TMHP, STAR plans, Novitas and commercial payers.
Learn more →Denial Management
Denials from Medicare, Texas Medicaid and commercial plans worked to resolution.
Learn more →Specialties We Bill For in Texas
Medical Billing in Texas: Common Questions
Do you provide medical billing services across Texas?
Yes. We work remotely with practices anywhere in Texas, including Houston, Dallas–Fort Worth, San Antonio, Austin, El Paso and rural areas, using your existing EHR and clearinghouse.
What is the Texas 95-day claim filing rule?
For many state-regulated HMO and PPO plans, Texas generally requires physicians and providers to submit claims within 95 days of the date of service. Claims filed late can be denied with no right to payment, so timely submission is critical. Self-funded employer plans and government programs follow their own rules.
Who processes Texas Medicaid claims?
Texas Medicaid fee-for-service claims are processed by the Texas Medicaid & Healthcare Partnership (TMHP) on behalf of HHSC. Most Medicaid members are enrolled in STAR managed care plans, which process their own claims.
Who is the Medicare contractor for Texas?
Novitas Solutions is the Medicare Administrative Contractor for Part A and Part B in Texas (Jurisdiction H).
Get Paid Faster by Texas Payers
Our free audit reviews your recent Texas claims, denials and A/R and shows you exactly what to fix.