Disclosure: Fastora Medical Billing Solutions publishes this guide, and Fastora is one of the companies included in it. We placed ourselves first and we are saying so plainly — judge us by the same criteria as every other company below. No company paid to be listed, and no outside organization produced or endorsed this comparison.
Texas is one of the hardest states in the country to bill in — not because the medicine is different, but because the payer landscape is. Most Texas Medicaid members are enrolled in Medicaid managed care, so the claim usually goes to a managed care organization rather than the state, and fee-for-service claims filed with TMHP (the Texas Medicaid & Healthcare Partnership) face a 95-day timely filing deadline from the date of service. “Do you bill in Texas?” is not the same question as “Do you know how Texas billing actually works?”
This guide compares seven medical billing companies that Texas practices genuinely consider, what each one is built for, and where each fits best. For the service-side view rather than a comparison, our page on Fastora’s medical billing services in Texas covers how we handle Texas billing day to day, and our hub shows our medical billing coverage across the United States.
How we evaluated these companies
Each company below was assessed against the same six criteria, using information from the companies’ own published materials:
- Scope of service — does the engagement stop at claim submission, or does it cover eligibility verification, prior authorizations, denial management, A/R follow-up, and payment posting?
- Texas payer knowledge — is there evidence the company works with Texas Medicaid (TMHP and the STAR plans) and the state’s filing deadlines?
- Specialty coverage — how well does the company handle rule-heavy Texas specialties, including behavioral health, therapy, and ABA?
- Pricing transparency — is pricing published, or quote-only? Is the model percentage-based, flat fee, per-claim, or subscription?
- Onboarding and switching effort — how much transition work falls on the practice?
- Reporting and visibility — can the practice see claim status, denial reasons, and A/R aging without having to ask?
The seven companies at a glance
| # | Company | Best for | Type |
|---|---|---|---|
| 1 | Fastora Medical Billing Solutions | Texas practices that want a service team to work the whole revenue cycle | Billing service / RCM |
| 2 | Transcure | Multi-specialty groups that want automation-led billing at scale | Billing service / RCM |
| 3 | PUREDI | Physician groups that want billing run on the vendor’s own software platform | Software + billing services |
| 4 | MedCare MSO | Practices, labs, and hospitals that want broad operational support from an MSO | Managed services organization |
| 5 | Swift Medical Billing | Independent and multi-specialty practices that want a service-led RCM partner | Billing service / RCM |
| 6 | eClaim Solution | Small and mid-size practices that want full-service billing and a free audit first | Billing service |
| 7 | CareCloud | Practices that want EHR, practice management, and RCM in one platform | Platform + RCM services |
1. Fastora Medical Billing Solutions
Texas is Fastora’s home market, and our billing work is organized around what Texas practices actually run into: Medicaid managed care claims routed to the member’s MCO, the 95-day TMHP filing deadline on fee-for-service Medicaid claims, and the authorization volume of the state’s large therapy, behavioral health, and ABA practices. Fastora’s team runs the revenue cycle end to end — eligibility verification, prior authorizations, claim submission with pre-submission review, denial management and appeals, payment posting, and follow-up on aged accounts, including a dedicated old A/R recovery service.
Why we placed ourselves first: most Texas practices that come to us do not have a billing manager, and platform-led options still expect someone in the office to work queues, watch denials, and chase payers. Our model removes that assumption — the work itself is handed over, not just the software for doing it. Fastora reports more than 5 years in medical billing and RCM, experience supporting 100+ physicians, and 50+ active clients. We also handle two services practices often discover they need after signing: provider credentialing and enrollment and a virtual front desk for scheduling and intake. Specialty depth matters in Texas, and our dedicated pages cover areas such as physical therapy billing services in Texas, where managed care and authorization rules drive most denials.
Pricing: Fastora charges either a percentage of collections or a flat monthly fee, set after a free billing assessment — the two models are explained on our pricing page. There is no published rate card, which is normal for service-led billing, but the model is stated up front.
Best fit: solo and small-group practices, behavioral health and therapy practices, and any Texas practice whose problem is workload and follow-through rather than software.
Getting started: before any contract is signed, Fastora runs a free initial billing audit of your claims, denials, and A/R, so the decision starts from your own numbers.
2. Transcure
Transcure is a large, automation-led billing company, founded in 2002, that provides end-to-end revenue cycle services — eligibility, prior authorizations, coding, claim submission, denial management, and A/R follow-up — across more than 40 specialties. It appears on nearly every published list of Texas billing companies and maintains a dedicated Texas offering addressing state rules such as Texas balance-billing protections. It works with dozens of EHR systems and also offers credentialing.
Strengths: scale, a broad specialty bench, and a workflow built around automation. Considerations for Texas practices: automation delivers the most at higher volumes; smaller practices should confirm who reviews exceptions and denials personally, and how Texas Medicaid managed care claims are handled day to day.
3. PUREDI
PUREDI is headquartered in Austin, Texas, and has been billing for physician practices for more than two decades. What sets it apart is that it runs its billing services on its own proprietary cloud-based software, with an integrated clearinghouse, claim scrubbing and error checking before submission, eligibility verification, and detailed reporting and analytics. Its published services also include coding, credentialing and contracting, and practice management consulting, with specialty experience across groups including hospitalists, behavioral health, cardiology, and physical therapy.
Strengths: a Texas base, its own platform rather than a third-party system, and a consulting layer on top of billing. Considerations: because the service runs on PUREDI’s software, confirm how it connects with your existing EHR; full-service pricing is quoted rather than published.
4. MedCare MSO
MedCare MSO is a revenue cycle management company founded in 2012 that operates as a managed services organization: beyond medical billing and coding, its published services include credentialing, A/R recovery, and wider operational support for practices, laboratories, diagnostic centers, and hospitals. It serves providers nationwide, including statewide Texas coverage, and its model is built around taking over back-office workload rather than selling software.
Strengths: breadth — billing plus the operational services around it. Considerations: an MSO engagement can reach well beyond billing, so define the scope precisely in the contract: which services are included, what the Medicaid managed care workflow looks like, and what reporting cadence you will actually receive.
5. Swift Medical Billing
Swift Medical Billing (Swift MDS) presents itself as a service-led RCM partner for independent and multi-specialty practices. Its published offering covers full-cycle revenue management — claims, denial management, audits, and credentialing — for practices that want a billing team rather than a platform to administer themselves.
Strengths: a focused, service-led model with credentialing and audit work in the same engagement. Considerations: ask for Texas-specific references — particularly practices billing STAR managed care plans — and confirm how the 95-day TMHP deadline is tracked for fee-for-service Medicaid volume.
6. eClaim Solution
eClaim Solution is a full-service billing company with more than a decade in the field, serving small clinics and mid-size practices. Its published services include automated eligibility verification, claim submission, coding across CPT, ICD-10, and HCPCS code sets, denial management, credentialing support, and a free medical billing audit for prospective clients.
Strengths: a complete service menu at small-practice scale, and a free audit that lets a practice evaluate fit before committing. Considerations: confirm which parts of the published menu are included in the standard engagement versus add-ons, and ask how denial follow-up is staffed and reported.
7. CareCloud
CareCloud combines practice management and EHR software with RCM services, and it is best known for its reporting and analytics layer — dashboards and benchmarking across the revenue cycle. For Texas practices, it is the platform-led entry on this list: the billing service is best evaluated together with its software, not as a stand-alone engagement.
Strengths: an integrated platform-plus-services model with strong analytics. Considerations: if your practice is committed to its current EHR, weigh the switching cost honestly — the model delivers the most when the practice adopts the platform.
How to choose the right company for your Texas practice
Start with the Texas-specific questions, because they eliminate more vendors than any feature checklist. Ask every company on your shortlist: How do you track the 95-day TMHP timely filing deadline? For STAR managed care members, do you bill the member’s MCO directly, and how do you verify which plan a member is in before the visit? Who works a denied claim, and how fast? What does the monthly report show — and can you see a sample before signing? Our full guide on how to choose a medical billing company walks through the general evaluation step by step.
Then match the model to your actual problem. If claims go out but denials sit unworked and A/R ages, your problem is follow-through, and a service-led company matters more than new software. If your staff is capable and your tools are the bottleneck, a platform-led option like PUREDI or CareCloud may be the better buy. Either way, get the contract terms in writing: term length, exit terms, and data ownership if you leave.
Frequently asked questions
How much do medical billing companies charge in Texas?
Service-led companies usually charge a percentage of collections or a flat monthly fee; platform companies usually charge a per-provider subscription, sometimes combined with a percentage. Rates vary widely with specialty, volume, and scope, which is why most service companies quote after reviewing the practice. What matters is what the price includes — a lower percentage that excludes denial follow-up and credentialing can cost more in lost revenue than a fuller-service quote.
What is the Texas Medicaid timely filing deadline?
Fee-for-service Texas Medicaid claims filed with TMHP must be submitted within 95 days of the date of service, per the TMHP provider manual. Most Texas Medicaid members are in Medicaid managed care, however, and those claims go to the member’s managed care organization under that plan’s own rules. A Texas billing partner should be able to explain both tracks without hesitating.
Does it matter whether a billing company is based in Texas?
Not by itself. What matters is demonstrated Texas payer knowledge: STAR managed care routing, TMHP deadlines, and the commercial mix in your metro. A Texas-based company like Fastora or PUREDI starts with that familiarity built in, but a national company that can show you its Texas Medicaid workflow in detail can also do the job. Judge the workflow, not the ZIP code.
Can a Texas practice switch billing companies without disrupting cash flow?
Yes, if the transition is planned: run the new biller in parallel briefly, confirm payer enrollments and EDI connections before the cutover, and make sure someone owns the old A/R — worked by the outgoing biller to a defined end date or transferred with a written inventory. With a 95-day Medicaid filing window, a sloppy handoff is more dangerous in Texas than in most states.
Do these companies work with my EHR?
Platform companies (PUREDI, CareCloud) run billing on their own systems and integrate with, or replace, your EHR setup. Service-led companies (Fastora, Transcure, MedCare MSO, Swift Medical Billing, eClaim Solution) typically work through your existing EHR and clearinghouse. Confirm compatibility with your specific system before signing either way.
What specialties do Texas billing companies cover?
Most cover primary care and common specialties. Where companies differ is depth in rule-heavy areas — behavioral health, ABA, and physical and occupational therapy, which carry heavy authorization and unit-based rules in Texas Medicaid managed care. Ask for the workflow in your specialty specifically, not a specialty count.
Conclusion
For a Texas practice, the best medical billing company is the one that knows this state’s payers and deadlines cold, and whose model matches your actual bottleneck. Platforms like PUREDI and CareCloud put strong tools in your office. Service-led companies like Fastora take the work itself off your office — including the TMHP and STAR follow-through Texas billing demands.
Looking for a more reliable billing partner in Texas? Fastora provides medical billing and revenue cycle management support for eligible healthcare practices. Request your free initial billing audit to discuss your practice’s billing workflow and identify areas for improvement.
Sources: company descriptions are drawn from each company’s own published materials (Transcure, PUREDI, MedCare MSO, Swift Medical Billing, eClaim Solution, CareCloud), reviewed October 2026. Texas Medicaid facts: Texas Medicaid & Healthcare Partnership (TMHP) Texas Medicaid Provider Procedures Manual, as recorded in Fastora’s state research, verified 2026-10-23. Fastora company figures are company-reported.
