Medical Billing Services That Recover the Revenue Your Practice Is Losing
Certified coders, fast claim follow-up and clear monthly reporting, so you get paid in full for every patient you see.
- HIPAA Compliant
- AAPC-Certified Coders
- Works With Your EHR
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A Billing Team That Treats Texas as Its Own Market
Plenty of billing companies serve Texas the same way they serve Ohio. That’s where the trouble starts. Texas has its own Medicaid structure, its own workers’ comp system, its own surprise billing law and a set of payers you won’t see anywhere else.
We’ve been doing this since 2010. Every Texas client gets a payer map on day one: which Medicaid plans you see, which commercial contracts you hold, how much of your work is Medicare, comp or self-pay.
- Certified, specialty-trained billing experts
- Transparent reporting and honest communication
- Solutions for solo practices to large groups
What does a Texas medical billing company do?
A Texas medical billing company codes, submits and follows up on a practice's insurance claims under Texas rules. That includes billing the right Medicaid managed care plan within the 95-day filing limit, sending Medicare Part A and B claims to Novitas Solutions and DME claims to CGS, holding state-regulated insurers to the 30- and 45-day prompt pay deadlines, and billing workers' comp under either the state fee guideline or the employer's own plan.
Averages across CoreMedix clients. Your results depend on specialty, payer mix and where your A/R stands when we start.
Why Texas Claims Stall and What We Do About It
Most Texas practices we talk to aren’t short on patients. They’re short on billing hours, and certain claims fall through every month.
About 97% of Texas Medicaid clients are in managed care, tied to the member's PCP of record.
We check the member's current plan and PCP before every visit, not once a year.
Texas Medicaid and CHIP give you only 95 days from date of service.
Claims go out within 24 hours of charge entry, rejections fixed same day.
Non-subscriber injuries are billed to the employer's own plan, not DWC.
We confirm the employer's comp status at intake and bill accordingly.
State-regulated plans owe penalties for late payment, rarely tracked.
Every claim is flagged past its deadline, so penalties get claimed.
Texas Medicare: Novitas for Part A and B, CGS for DME
Visit, procedure and hospital claims go to one contractor, and supplies and equipment go to another, each with its own coverage policies and edits.
Novitas Solutions, Jurisdiction H · Part A and B. Covers TX, AR, CO, LA, MS, NM, OK.
CGS Administrators, DME MAC Jurisdiction C. Covers TX plus 14 other states, Puerto Rico, U.S. Virgin Islands.
Medicare’s filing limit is 12 months, but we don’t wait — claims go out on the same 24-hour cycle as everything else.
Texas Medicaid Billing: STAR Plans, TMHP and the 95-Day Rule
STAR
Most children, pregnant women and low-income families.
STAR+PLUS
Adults 65+ and adults with disabilities, incl. long-term services.
STAR Kids
Children and young adults up to age 20 with disabilities.
STAR Health
Children in foster care and young adults aged out, statewide.
CHIP
Children in families who earn too much for Medicaid.
How We Keep Texas Medicaid Claims Paid
- Eligibility checked every visit through TMHP and the plan portal
- 95-day tracking, escalated at day 60
- Plan-specific appeal windows and addresses kept current
- TMHP enrollment, revalidation and credentialing handled
Texas Laws That Show Up on Your Claims
These aren’t just compliance items. Each one changes how a claim should be billed, when it should be paid or how much you can recover.
- Texas Prompt Pay Act — 30/45-day clean claim payment, with penalties for late payers
- Surprise Billing, SB 1264 — bans balance billing for emergency and certain out-of-network care
- Gold Card Law — exempts high-approval physicians from prior authorization
- Workers' Comp Fee Guideline — Medicare-based rates with Texas conversion factors, 95-day due date
- Non-Subscriber Employers — Texas is the only state where workers' comp is truly optional
How We Take Over Your Billing Without Missing a Beat
We review claims, denials and A/R to show where revenue is leaking.
Every payer you bill mapped with its filing and appeal rules.
We connect to your EHR and clearinghouse, no new software.
Claims closest to a deadline go to the front of the line.
Charges coded, scrubbed and submitted within 24 hours.
Your account manager walks you through the numbers monthly.
Specialty-Focused Medical Billing
We Work Inside the EHR You Already Use
Medical Billing Across Texas, Region by Region
We work remotely with practices statewide. Payer mix changes a lot from one region to the next.
Houston
Texas Medical Center brings heavy specialty volume and out-of-network disputes.
Dallas–Fort Worth
Strong commercial and self-funded employer mix.
San Antonio
South Texas referral hub, high Medicaid, TRICARE near Ft. Sam Houston.
Austin & Central Texas
Fast-growing independent practices needing quick credentialing.
El Paso
Border market, heavy Medicaid and TRICARE near Fort Bliss.
Rio Grande Valley
Very high Medicaid and CHIP share, 95-day limit drives cash flow.
Why Texas Practices Choose CoreMedix
You get one account manager who knows your practice, certified coders who understand your specialty, and no long-term contract holding you in place.
- One dedicated account manager who knows your practice by name
- Paid only when you are paid, no setup fee
- Texas filing and appeal deadlines tracked on every claim
- Certified coders with specialty experience, since 2010
Medical Billing for Every Major Payer
Every payer has its own rules, filing limits and denial patterns. We know them in detail, so more claims are accepted the first time.
In-House Billing vs. CoreMedix: What It Really Costs
Median Texas medical records specialist salary: about $48,860 (May 2024), not including benefits, software or lost collections when someone quits. CoreMedix charges only a percentage of what we collect.
HIPAA and Texas Privacy Compliance
What Clients Say About Us
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Tell us about your practice. A billing specialist will show you exactly where revenue is being lost.
- No cost and no commitment
- Results delivered within one week
- Your data stays confidential
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Texas Medical Billing FAQs
Novitas Solutions processes Texas Medicare Part A and B as Jurisdiction H. DME claims go to CGS Administrators under Jurisdiction C.
Texas Medicaid and CHIP claims generally must be filed within 95 days of the date of service.
About 97% of Texas Medicaid clients are in managed care, so most claims go to a health plan tied to the member’s PCP.
Under the Texas Prompt Pay Act, state-regulated plans must pay a clean claim within 30 days electronically or 45 on paper, with penalties for late payment.
Yes. SB 1264 protects patients in state-regulated plans from surprise bills for emergency and certain out-of-network care, with arbitration through TDI.