Medical Billing Services Across the United States

Fastora Medical Billing Solutions is based in Texas, but the practices we bill for are not. Claims, eligibility checks, and remittances all move electronically now, so a billing team does not need to sit in your office — or even in your state — to do the work well. What does change across state lines is the rulebook. Medicaid is run by each state, enrollment requirements differ, and filing deadlines in one state can be half of what they are in another. That is the part a nationwide billing partner actually has to get right, and it is what this page is about.

The work itself is the same wherever your practice sits: eligibility verification before the visit, clean claim submission, denial follow-up and appeals, payment posting, corrected claims, and steady work on aging accounts receivable. If you would rather start with the services than the geography, you can explore Fastora’s billing and RCM services first. This page covers where we do that work, state by state, and what differs in each place.

Fastora works with 50+ active clients and supports 100+ physicians, with 5+ years of experience in medical billing. Texas is our home market and still our deepest one. The sections below start there, then cover the states where we are building dedicated pages, then the rest of the country in shorter form.

How Remote Billing Works Across State Lines

Enrollment comes before billing

A billing company cannot submit claims for a practice that is not enrolled with the payer. For state Medicaid programs, that means the provider — and in some states the billing group as well — must be enrolled and in good standing before the first claim goes out, and enrollment has to be revalidated on the state’s schedule. When we start with a practice in a new state, the first job is checking enrollment status with every payer on its roster, commercial and Medicaid alike, and fixing gaps before they turn into denials.

Medicaid is fifty different programs

Medicaid goes by a different name in most states — Medi-Cal in California, TennCare in Tennessee, AHCCCS in Arizona, Apple Health in Washington — and the differences are more than cosmetic. Some states deliver most benefits through managed care organizations, so claims go to the member’s health plan rather than the state. Some carve behavioral health out into separate plans. Portals, prior authorization rules, and covered-service policies all vary. A claim that pays without incident in one state can deny in another for a purely administrative reason, which is why state program rules are part of the billing workflow and not an afterthought.

Filing deadlines are set by the state

Medicare’s timely filing window is federal and the same everywhere. Medicaid deadlines are not. Each state sets its own, and some allow only about three months from the date of service while others allow considerably longer. Commercial payers set deadlines in their contracts, and those vary by plan. A missed deadline usually means the charge cannot be billed to the patient either — it is simply written off. Tracking each payer’s clock, by state and by plan, is unglamorous work, and it is where a disciplined billing process protects real money.

Texas

Texas is where Fastora started, and it remains the state where our coverage runs deepest. Our medical billing services in Texas page is the hub for it. Texas Medicaid claims filed with TMHP carry a 95-day timely filing deadline from the date of service, and most Medicaid members are in managed care, so their claims go to the member’s health plan rather than the state. Our Texas Medicaid billing guide walks through those rules in detail. Therapy, behavioral health, psychiatry, ABA, and pain management practices make up a large share of the Texas work.

Austin

Austin’s therapy, behavioral health, and group-practice scene keeps growing with the city itself. Our medical billing services in Austin, Texas page covers what we do for practices there.

Houston

Houston has one of the largest concentrations of hospitals and specialty practices in the country, and the payer mix to match. See our medical billing services in Houston page for the local picture.

Dallas–Fort Worth

Dallas and Fort Worth function as one practice market, so we cover them on one page: medical billing services in Dallas–Fort Worth.

San Antonio

San Antonio’s military and retiree population gives its practices a payer mix unlike the other big Texas metros. Our medical billing services in San Antonio, Texas page covers billing support for practices there.

California

California is the largest practice market in the country, and Medi-Cal is where its billing gets complicated. Behavioral health under Medi-Cal is split: some services bill to the member’s managed care plan, while specialty mental health services bill to the county mental health plan, so the same practice can route similar claims to different payers depending on the service. Getting that routing wrong is a reliable source of denials. We work with practices across Los Angeles, Orange County, San Diego, San Jose, the San Francisco Bay Area, Sacramento, the Inland Empire, and Fresno, with behavioral health, psychiatry, ABA, psychology, and therapy practices making up much of the California work. Our medical billing services in California page and our dedicated page on psychiatry billing for California practices go into the Medi-Cal detail.

Florida

Most Florida Medicaid services run through the Statewide Medicaid Managed Care program, and the detail that trips practices up is enrollment: for Managed Medical Assistance claims to pay, both the rendering provider and the billing group must be actively enrolled in Florida Medicaid. Florida is also the most Medicare-heavy large state in the country, so geriatrics, cardiology, therapy, and podiatry volume is high, with strong behavioral health demand in South Florida. We bill for practices in Miami, Fort Lauderdale, West Palm Beach, Orlando, Tampa, St. Petersburg, Jacksonville, and Fort Myers/Naples. The state picture is on our medical billing services in Florida page, with separate pages for mental health billing for Florida practices and medical billing services in Miami.

New York

New York Medicaid fee-for-service claims run through eMedNY, and the filing rule is strict: claims generally must be submitted within 90 days of the date of service, with a two-year final ceiling. Managed care claims follow each plan’s own rules instead, so a practice has to know which clock applies to which claim. The New York City metro has a concentration of psychiatry and psychology practices unlike anywhere else in the country, and behavioral health, ABA, and therapy billing volume is high across Long Island, Westchester, Buffalo, Rochester, Syracuse, and Albany as well. Our medical billing services in New York page covers the state in full.

Pennsylvania

Pennsylvania’s Medicaid managed care program is HealthChoices — but behavioral health is carved out of it. Behavioral HealthChoices is run county by county through its own plans, which means a behavioral health claim routes completely differently from a physical health claim for the same patient. Practices that bill both kinds of services have to work in both systems. We bill for practices in Philadelphia, Pittsburgh, Harrisburg, the Lehigh Valley, Scranton/Wilkes-Barre, Erie, and Lancaster, with behavioral health, substance use treatment, psychiatry, and geriatrics among the busiest specialties. Our medical billing services in Pennsylvania page explains how the carve-out affects day-to-day billing.

Illinois

Illinois Medicaid managed care is HealthChoice Illinois, and because most Medicaid members are enrolled in managed care organizations, plan-level rules — not state fee-for-service rules — govern most claims. Chicago is one of the three largest practice markets in the country and has an unusually dense network of federally qualified health centers alongside its behavioral health, ABA, therapy, and pain management practices. Downstate, Naperville and Aurora, Springfield, Rockford, Peoria, and Champaign add mid-size group practices with the same managed care billing questions. See our medical billing services in Illinois page and our page on medical billing services in Chicago.

Ohio

Ohio Medicaid runs through managed care under the Ohio Department of Medicaid, and the change Ohio practices are feeling most right now is the move to Next Generation MyCare Ohio in 2026, which shifted billing for dual-eligible patients — Medicare and Medicaid together — into new integrated plans. Practices with many dual-eligible patients, which includes a lot of pain management and substance use treatment programs, have had established billing routines change under them. We work with practices in Columbus, Cleveland, Cincinnati, Dayton, Toledo, and Akron. Our medical billing services in Ohio page has the state detail, and pain practices can go straight to pain management billing for Ohio practices.

Georgia

For Georgia Medicaid and PeachCare for Kids members in managed care, the claim does not go to the state — it goes to the member’s care management organization under the Georgia Families program. Billing the wrong entity is a common and avoidable denial for practices new to the program. Atlanta anchors the state’s practice market, with Savannah, Augusta, Columbus, Athens, and Macon behind it, and the combination of a large pediatric Medicaid population and active behavioral health sector keeps ABA, psychiatry, and therapy billing busy. Our medical billing services in Georgia page covers the state.

North Carolina

North Carolina moved most Medicaid members into managed care, and the mechanics still generate friction: providers enroll through NCTracks, then bill the member’s Prepaid Health Plan, while the remaining fee-for-service populations bill NC Medicaid Direct through NCTracks. Practices that trained their workflows on the old system have had to relearn where claims go. Charlotte, Raleigh, Durham, Greensboro, Winston-Salem, Asheville, and Wilmington are the main practice centers, with behavioral health, psychiatry, ABA, and therapy among the busiest billing areas. See our medical billing services in North Carolina page and our page for medical billing services in Raleigh.

Michigan

Michigan’s practice market is anchored by Detroit and Grand Rapids, with Ann Arbor, Lansing, Troy, and Kalamazoo behind them. Rehabilitation and therapy volume is substantial in both big metros, and substance use treatment billing is a significant part of the state’s behavioral health work alongside psychiatry and counseling. Payer mixes vary a great deal between the big health-system markets and the independent practices around them, so our Michigan work starts the way it does everywhere: an enrollment and payer-contract review, then the state’s plan-by-plan filing rules built into the daily workflow. Our medical billing services in Michigan page covers the state.

New Jersey

New Jersey is the most densely populated state in the country, and its practices sit in two big corridors — the New York metro in the north and the Philadelphia metro in the south. NJ FamilyCare, the state’s Medicaid program, delivers most benefits through managed care organizations, so most Medicaid claims go to the member’s plan. Newark, Jersey City, Edison and New Brunswick, Princeton and Trenton, Paterson, Cherry Hill, and Hackensack all hold deep benches of psychiatry, ABA, cardiology, and therapy practices. Our medical billing services in New Jersey page has the full picture.

Virginia

Virginia consolidated its Medicaid program under Cardinal Care in October 2023, putting managed care and fee-for-service members under one program. Two requirements follow from that structure: providers enroll and revalidate through the state’s PRSS portal, and a practice contracts with each managed care organization separately — enrollment with the state alone does not finish the job. Northern Virginia’s practice density leads the state, with Richmond, Virginia Beach, Norfolk, Charlottesville, and Roanoke behind it, and psychiatry and ABA are especially active. Our medical billing services in Virginia page goes through the enrollment side in detail.

Massachusetts

MassHealth covers most of its members through managed care or accountable care arrangements, which means the first billing question in Massachusetts is usually which plan a claim belongs to. Boston is a national center for academic medicine and behavioral health, and the psychiatry, psychology, ABA, and eating disorder treatment programs concentrated there and in Cambridge bill some of the most payer-specific rules in the country. Worcester, Springfield, and Lowell round out the practice centers we serve. Our medical billing services in Massachusetts page covers the state.

More States We Serve in the South and Southeast

Tennessee

Tennessee’s Medicaid program is TennCare, and nearly every member is in a contracted managed care organization, so plan rules govern most claims a Tennessee practice sends. Nashville is a national center for healthcare companies and group practices, while Memphis and Knoxville carry large Medicaid-heavy markets. Behavioral health, substance use treatment, and pain management are the busiest billing areas; our national page on behavioral health billing services covers the specialty, and Nashville practices can read about medical billing services in Nashville. The statewide picture is on our Tennessee medical billing services page.

Alabama

Birmingham and Huntsville hold Alabama’s large hospital hubs, and much of the rest of the state is served by smaller independent practices in places like Montgomery, Mobile, and Tuscaloosa. Family practice, therapy, and pain management billing make up much of the work, and facility-side billing matters here too — see our hospital billing services page. Statewide detail is on our medical billing services in Alabama page.

South Carolina

Charleston, Columbia, and Greenville anchor South Carolina’s practice growth, with Spartanburg and Myrtle Beach behind them. Retiree inflows along the coast keep cardiology and geriatric practices busy; our cardiology billing services page covers that specialty in depth. Our South Carolina medical billing services page covers the state in full.

Kentucky

Louisville and Lexington hold most of Kentucky’s practice density, with Northern Kentucky and Bowling Green behind them. Substance use treatment demand is high across the state, and residential programs carry billing requirements of their own — our residential treatment billing services page explains how that billing works. The full state picture is on our Kentucky medical billing services page.

Louisiana

New Orleans and Baton Rouge concentrate Louisiana’s hospital systems and group practices, with Shreveport, Lafayette, and Metairie behind them. A high share of Medicaid enrollment and a heavy chronic-disease burden shape the payer mix, and internal medicine practices carry much of it — see our internal medicine billing services page. Our medical billing services in Louisiana page covers the state.

Oklahoma

Oklahoma Medicaid is SoonerCare, administered by the Oklahoma Health Care Authority. Oklahoma City and Tulsa are the two practice centers, with Norman and Lawton behind them, and behavioral health and family practice billing account for much of the state’s outsourced work. Our family practice billing services page covers the specialty most Oklahoma independents rely on. Our medical billing services in Oklahoma page covers the state in full.

Maryland

Baltimore’s academic medical centers and the affluent suburbs between Washington and Baltimore — Bethesda, Rockville, Silver Spring, Columbia — give Maryland an unusually dense concentration of psychiatry and psychology practices. Our page on billing services for psychologists goes into that specialty’s payer rules. Statewide coverage is detailed on our medical billing services in Maryland page.

More States We Serve in the Midwest

Indiana

Indianapolis anchors Indiana’s hospital and group-practice market, with Fort Wayne, Evansville, South Bend, and Carmel behind it. Substance use treatment and behavioral health billing are in steady demand statewide; our substance use treatment billing page covers how that work is billed. Our Indiana medical billing services page covers the state.

Missouri

Missouri has two anchor metros — St. Louis and Kansas City — each with large hospital systems, plus Springfield, Columbia, and St. Charles. Therapy practices are a consistent part of the billing mix in both metros; see our occupational therapy billing services page. Statewide coverage is on our Missouri medical billing services page.

Wisconsin

Milwaukee and Madison anchor Wisconsin’s market, with Green Bay, Appleton, and Eau Claire behind them. Strong health-system presence shapes the payer mix, and therapy billing — including the documentation-heavy side of it — is a steady part of the work. Our speech therapy billing services page covers one of the most rule-specific therapy specialties. Statewide detail is on our medical billing services in Wisconsin page.

Minnesota

The Twin Cities of Minneapolis and St. Paul hold most of Minnesota’s practices, and Rochester adds a major clinic hub with national reach. An older population and a strong rehabilitation sector keep geriatric and therapy billing busy; our geriatric billing services page covers billing for practices that serve older patients. The full state picture is on our Minnesota medical billing services page.

More States We Serve in the West

Arizona

Arizona’s Medicaid program is AHCCCS, an integrated managed care program: physical and behavioral health are delivered through contracted health plans rather than fee-for-service, which makes plan routing the central billing question in the state. The Phoenix metro — with Scottsdale, Mesa, and Tucson behind it — is growing fast, and its retiree population keeps geriatric, therapy, and pain practices busy. Phoenix practices can read about medical billing services in Phoenix. The full state picture is on our Arizona medical billing services page.

Colorado

The Denver metro concentrates Colorado’s group practices, with Aurora, Colorado Springs, Boulder, and Fort Collins behind it. An active population keeps physical therapy, orthopedics, and pain management busy, and behavioral health practices are well established across the Front Range. Denver practices can read about medical billing services in Denver. The full state picture is on our Colorado medical billing services page.

Oregon

Portland dominates Oregon’s practice market, with Eugene, Salem, Bend, and Medford behind it. Behavioral health and substance use treatment form an unusually large share of the state’s outpatient sector, and community health centers carry a significant part of primary care — our FQHC billing services page covers billing for those centers. The statewide picture is on our medical billing services in Oregon page.

Washington

Washington’s Medicaid program is Apple Health, administered by the Health Care Authority, and it delivers physical and behavioral health services largely through managed care plans — the two are integrated rather than carved apart. Seattle and Bellevue lead the practice market, with Spokane, Tacoma, Vancouver, and Everett behind them, and behavioral health is the lead specialty across them. Seattle practices can read about medical billing services in Seattle. Statewide detail is on our medical billing services in Washington page.

New England and the Mid-Atlantic

Connecticut

Hartford, New Haven, Stamford, and Bridgeport sit in the corridor between New York and Boston, and the state’s practices lean private and specialty-heavy — psychiatry, psychology, and ABA practices are common, and their billing is plan-specific. The full state picture is on our Connecticut medical billing services page.

Delaware

Delaware is effectively a one-metro state centered on Wilmington, with Newark and Dover behind it. Practice counts are small, and most of the billing work is family practice, therapy, and geriatric care. Statewide coverage is on our Delaware medical billing services page.

Maine

Portland is Maine’s only real practice hub, with Bangor and Lewiston/Auburn behind it. The population is older and spread out, and behavioral health and substance use treatment are the specialties that most often look for billing help. The full state picture is on our Maine medical billing services page.

New Hampshire

Manchester and Nashua lead a small market whose southern tier works closely with the Boston area. Behavioral health and substance use treatment practices are the most common billing clients in the state. Our New Hampshire medical billing services page covers the state.

Rhode Island

Providence, Warwick, and Cranston make up nearly the whole Rhode Island market. It is compact, and behavioral health, psychiatry, and therapy practices account for most of the billing work. Our medical billing services in Rhode Island page covers the state.

Vermont

Burlington is Vermont’s only metro of size, with Rutland and the Montpelier area behind it. Small family practices and behavioral health providers make up most of the state’s billing work. The full state picture is on our Vermont medical billing services page.

The Plains, Mountain West, and Pacific

Alaska

Anchorage holds most of Alaska’s practices, with Fairbanks, Juneau, and the Mat-Su area behind it. Care leans heavily on telehealth, and behavioral health and substance use treatment are the dominant billing needs. State specifics are on our Alaska medical billing services page.

Arkansas

Little Rock anchors Arkansas hospital care, and the Fayetteville–Springdale–Rogers corridor in the northwest is adding group practices quickly. Elsewhere the state is mostly small independent family and therapy practices. Our medical billing services in Arkansas page covers the state.

Hawaii

Honolulu is Hawaii’s single practice center, with Maui and the Big Island behind it. Island geography shapes scheduling and follow-up, and geriatrics, family practice, and therapy make up most of the billing. Our medical billing services in Hawaii page covers the state in full.

Idaho

Boise and Meridian hold most of Idaho’s practices, with Coeur d’Alene, Idaho Falls, and Twin Falls behind them. The market is growing quickly but still small, and family practice and therapy billing lead it. The statewide picture is on our medical billing services in Idaho page.

Iowa

Des Moines, Cedar Rapids, Davenport, Iowa City, and Sioux City are Iowa’s practice centers. Many are independent practices serving an older, rural-leaning population, and family practice and therapy billing predominate. State details are on our Iowa medical billing services page.

Kansas

Wichita and the Kansas City suburbs around Overland Park hold most Kansas practices, with Topeka and Lawrence behind them. Behavioral health, family practice, and therapy make up most of the billing work. Our Kansas medical billing services page covers the state.

Mississippi

Jackson leads Mississippi’s market, with the Gulfport–Biloxi coast, Hattiesburg, Tupelo, and Oxford behind it. Chronic disease burden is high and practice density is low, so family practice and cardiology billing carry much of the load. State specifics are on our Mississippi medical billing services page.

Montana

Billings is Montana’s only mid-size hub, with Missoula, Great Falls, Bozeman, and Helena behind it. Practices are small and far apart, and behavioral health and family practice are the common billing needs. Our medical billing services in Montana page covers the state.

Nebraska

Omaha and Lincoln hold nearly all of Nebraska’s practice density, with Grand Island and Kearney behind them. Family practice, behavioral health, and therapy billing make up most of the work. Statewide details are on our Nebraska medical billing services page.

Nevada

Las Vegas is Nevada’s dominant metro by a wide margin — Henderson, North Las Vegas, and Reno are distant seconds — and its urgent care and pain management sectors are outsized for the state’s population. Las Vegas practices can read about medical billing services in Las Vegas. The full Nevada picture is on our medical billing services in Nevada page.

New Mexico

Albuquerque leads New Mexico, with Santa Fe, Las Cruces, and Rio Rancho behind it. The state has a strong community behavioral health sector, including certified community behavioral health clinics — our CCBHC billing services page covers that billing model. State specifics are on our medical billing services in New Mexico page.

North Dakota

Fargo, Bismarck, Grand Forks, and Minot are North Dakota’s only hubs, and it is one of the smallest practice markets in the country. Family practice, behavioral health, and therapy billing cover most of it. The statewide picture is on our North Dakota medical billing services page.

South Dakota

Sioux Falls is a genuine regional medical center and Rapid City is the second hub, with Aberdeen behind them. Practice counts stay small, and family practice and geriatric billing lead. State details are on our South Dakota medical billing services page.

Utah

Utah’s practices concentrate along the Wasatch Front — Salt Lake City, Ogden, Provo — with St. George growing in the south. A young population tilts the work toward pediatrics, family practice, and therapy. Our medical billing services in Utah page covers the state in full.

West Virginia

Charleston, Huntington, Morgantown, and Parkersburg are West Virginia’s practice centers. Substance use treatment need is as high here as anywhere in the country, even though absolute practice counts are small, and behavioral health billing follows from that. Statewide coverage is on our West Virginia medical billing services page.

Wyoming

Cheyenne and Casper lead the smallest state market in the country, with Laramie and Jackson behind them. Family practice, behavioral health, and therapy practices make up most of what billing there is. Our medical billing services in Wyoming page covers the state.

Specialties We Bill for in Every State

Geography changes the payer rules; it does not change the specialty work. The same billing teams that handle behavioral health in Texas handle it in Florida and Pennsylvania, working within each state’s program structure. Our psychiatry billing services and our page for billing for therapists and counselors cover the mental health specialties, including psychology and counseling practices. ABA therapy billing is a specialty of its own, with authorization and session documentation rules that generalist billers often miss.

On the therapy side, our physical therapy billing services and rehabilitation billing services cover physical, occupational, and speech therapy, including the visit-cap and modifier rules those claims turn on. Our pain management and PM&R billing services page covers pain practices. Beyond those, we bill for substance use treatment programs, psychology practices, federally qualified health centers, geriatric and cardiology practices, podiatry, family practice, and a range of other physician specialties — the specialty list on this site runs to more than sixty pages because the billing rules genuinely differ that much from one specialty to the next.

Frequently Asked Questions

Can a billing company in another state really handle our claims?

Yes. Claims submission, eligibility verification, denial follow-up, and payment posting are all electronic, and none of them depends on the biller’s location. What matters is whether the billing team knows your payers — including your state’s Medicaid program, its managed care plans, and its filing deadlines — and has your enrollment in order. Those are the things we verify before the first claim goes out.

Does medical billing actually differ from state to state?

The clinical side does not; the administrative side does. Medicaid is a different program in every state, with different names, enrollment processes, managed care structures, and filing deadlines. Medicare rules are federal, though regional contractor policies vary. Commercial payer contracts are negotiated practice by practice. A billing process built for one state usually needs real adjustment before it works cleanly in another.

Do we need to be enrolled with our state Medicaid program before you can bill for us?

Yes — enrollment is a property of your practice, not of your billing company, and claims for a non-enrolled provider will not pay. In some states the billing group must be enrolled as well. When we start with a practice, we check enrollment status with Medicaid and every commercial payer, flag anything missing or due for revalidation, and help get the paperwork completed before billing begins.

What does getting started look like for a practice outside Texas?

It starts with a review: your payer roster, enrollment status, current A/R, and recent denial patterns. From there we set up claim submission through your existing systems, confirm electronic remittance and payment routing, and take over the daily billing work — eligibility, submission, posting, and follow-up. The steps are the same as for a Texas practice; the state-specific payer setup is the only part that changes.

What does Fastora charge?

Pricing is either a percentage of collections or a flat monthly fee, set according to your specialty, claim volume, and payer mix. There is no standard rate we could quote honestly without seeing your billing first, which is why we start with the free audit described below.

Which specialties do you bill for outside Texas?

The same ones we bill for in Texas. Behavioral health, psychiatry, psychology and counseling, ABA, substance use treatment, physical, occupational and speech therapy, pain management, and a long list of physician specialties are all national work for us. The specialty section above links to the main ones.

Start With a Free Initial Billing Audit

If your billing is handled in-house or by a company that does not know your state’s programs, the practical first step is a look at the evidence: a sample of recent claims, your denial patterns, and how old your receivables have grown. Fastora’s free initial billing audit does exactly that, wherever your practice is located, and the findings are yours to keep whether or not we end up working together. Request a free initial billing audit and we will tell you plainly what we find.