Medical Billing Services in Texas

Medical billing services in Texas, built around Texas payers

Fastora provides medical billing services in Texas for physician practices, therapy clinics, behavioral health groups and outpatient facilities. We are headquartered in Austin and work remotely with practices across the state, inside the EHR/PM system you already use, with no software to install and no hidden setup fees.

Texas billing has its own rhythm. Fee-for-service Medicaid claims go to TMHP, most Medicaid members are in managed care plans, Medicare Part A and B claims go to Novitas Solutions, and state-regulated commercial plans follow Texas Department of Insurance (TDI) rules on claim filing and payment. A medical billing company in Texas has to keep all of those rulebooks straight for every claim.

Every claim we touch is handled by certified medical billing and coding professionals. Each practice gets a dedicated account contact, transparent dashboards, monthly performance reporting and a monthly review call.

Billing for Texas payers

Most Texas practices bill a mix of the payer types below. The rules that decide where a claim goes, how fast it must be filed and how payment disputes are handled differ by payer type, so the first step in any review is sorting your payer mix correctly.

Payer type	Where claims go	Rules to watch
Medicare Part A/B	Novitas Solutions, the Jurisdiction H MAC for Texas	Medicare enrollment, LCDs and NCCI edits
Texas Medicaid fee-for-service	TMHP	Filing within 95 days of the date of service; TMHP appeal deadlines
Medicaid managed care (STAR, STAR+PLUS, STAR Kids, STAR Health)	The member's managed care organization (MCO)	MCO contract, prior authorization lists and the 95-day filing rule in the HHSC Uniform Managed Care Manual
CHIP	The member's CHIP health plan	Plan-specific authorization and claim rules
State-regulated HMO, PPO and EPO plans	The carrier (for example BCBSTX for many Texas commercial members)	Texas Prompt Pay rules and the gold-card prior authorization law
Self-funded employer (ERISA) plans	The plan's claims administrator	Federal rules; Texas Prompt Pay does not apply
Workers' compensation	The insurance carrier	Texas Division of Workers' Compensation (DWC) billing rules and fee guidelines

The same member card can hide very different rules. A BCBSTX logo may sit on a fully insured PPO that follows Texas Prompt Pay, or on a self-funded employer plan that does not. We check the funding type during eligibility verification so follow-up timelines and appeal routes are right from the start.

BCBS Texas prior authorization

Blue Cross and Blue Shield of Texas directs providers to submit most prior authorization requests through the Availity Authorizations and Referrals tool. Some services are managed by vendors such as Carelon or EviCore, which use their own portals, and Texas Medicaid members have a separate Medicaid authorization portal reached through Availity.

Because the reviewing entity depends on the member's plan and the service, we confirm who reviews the request before submitting it, attach the clinical notes the reviewer asks for, and record the authorization number against the visit so the claim carries it.

Texas Medicaid and managed care

Texas runs Medicaid largely through managed care. HHSC contracts with MCOs to serve members in STAR (children, pregnant women and some families), STAR+PLUS (adults 65 and older and adults with disabilities), STAR Kids (children and young adults with disabilities) and STAR Health (children in foster care). CHIP covers children in families who earn too much for Medicaid. Texas Health Steps provides preventive checkups for Medicaid members from birth through age 20.

STAR, STAR+PLUS and STAR Kids are offered in 13 service areas, each with its own set of MCOs. The Travis service area includes Williamson and Hays counties, the Dallas and Tarrant service areas split the Metroplex, and the Harris service area takes in Fort Bend and Montgomery counties. STAR Health is the exception: one MCO, Superior HealthPlan, serves children in foster care statewide.

TMHP enrollment and claims

Texas Medicaid credentialing starts with enrollment through TMHP's Provider Enrollment and Management System (PEMS). Providers must be enrolled in Texas Medicaid before an MCO can contract with them, and each MCO then applies its own credentialing and contracting rules. PEMS also lets physicians start MCO credentialing alongside the Medicaid application, though using it is optional.

Claims for carved-out and fee-for-service services go to TMHP, which generally must receive them within 95 days of each date of service; appeals must reach TMHP within 120 days of the disposition date on the Remittance and Status report. Claims for managed care members go to the member's MCO, which the HHSC Uniform Managed Care Manual also gives 95 days from the date of service.

Our Texas Medicaid billing services cover eligibility checks that confirm the member's program and MCO on the date of service, MCO-specific authorization, claim submission to TMHP or the plan, and follow-up on denials. For a deeper walk-through, see our Texas Medicaid billing guide.

Texas-specific rules that affect your cash flow

Several Texas laws change how fast you are paid and what you can bill. They apply to state-regulated plans, so the first question is always whether the member's coverage is regulated by TDI.

Texas Prompt Pay Act timelines

For HMO, preferred provider and EPO plans regulated by TDI, physicians and providers must submit claims within 95 days after the date of service. The carrier must pay a clean claim within 30 days of receipt for electronic claims and 45 days for paper claims, and late payment carries statutory penalties. Self-funded ERISA plans, Medicaid, CHIP, Medicare Advantage and workers' compensation are outside these rules.

We track the receipt date of each clean claim so late payments can be identified and raised with the carrier. Our Texas Prompt Pay Act guide explains the deadlines and penalty process in more detail.

Texas gold-card prior authorization

Under HB 3459 (2021), state-regulated plans must exempt a physician from prior authorization for a service when the plan approved at least 90 percent of that physician's requests for the service during the evaluation period. HB 3812 (2025) moved the evaluation to a yearly cycle, kept the minimum of five requests for the service and limited when a plan can rescind an exemption. An exemption applies across the issuer's TDI-regulated plans, so it does not reach self-funded employer plans.

Clean, well-documented authorization requests help a practice qualify, so we keep an authorization log by service and payer. Read more in our article on the gold-card prior authorization law.

Workers' compensation through DWC

Texas workers' compensation is overseen by the TDI Division of Workers' Compensation. A health care provider generally may not submit a medical bill to the carrier later than the 95th day after the service, with limited exceptions such as a bill sent to the wrong carrier or a catastrophic event. Fees follow DWC fee guidelines unless a certified network contract applies.

Balance billing protections

Texas SB 1264 bars out-of-network providers and facilities from billing members of state-regulated plans more than their cost sharing for emergency care and for certain care they did not choose. Disputes go to TDI arbitration (physicians and other providers) or mediation (facilities). The federal No Surprises Act adds protections for other coverage types, and SB 2476 extended Texas protections to ground ambulance services.

Revenue cycle management in Texas, from front desk to final payment

Our revenue cycle management in Texas follows a three-phase workflow. The Virtual Assistant phase covers scheduling, registration, insurance verification and co-pays collected upfront. The Scriber phase records visit documentation in your EHR in real time. The billing phase covers claim submission, payment posting, denial management, AR follow-up and patient billing.

• Charge entry and Advanced Pre-Submission Claim Review before claims leave your system
• Denial management services for Texas payers, including appeals to MCOs, TMHP and commercial carriers
• AR follow-up and old AR cleanup, including aged Medicaid and workers' compensation balances
• Payment posting from ERAs and EOBs, with underpayment checks against your fee schedules
• Credentialing and payer enrollment through a tracked nine-stage process
• Patient statements and payment plans

Practices that want end-to-end healthcare RCM in Texas can hand off the full cycle; others choose medical billing outsourcing for Texas payers only, such as Medicaid managed care follow-up. Our denial management work sorts each denial by root cause so the fix happens upstream, not claim by claim.

For physician billing services in Texas, coders review E/M levels and modifiers against documentation, and charges for Medicaid members are checked against the plan's coverage before submission.

Credentialing services in Texas

A provider who is not enrolled cannot be paid, and in Texas Medicaid that means TMHP enrollment first and MCO credentialing second. Our credentialing services for Texas practices follow a tracked nine-stage process: consultation, document collection, state licensing, NPI and CAQH setup, payer applications, panel submissions, follow-ups, final approval and ready to bill.

We keep CAQH profiles current, track revalidation dates, and line up Medicare enrollment through Novitas with commercial and Medicaid panels so new providers can start billing as soon as payers allow. Learn more about provider credentialing and enrollment.

Specialties we serve in Texas

We work with outpatient providers across physician, therapy, behavioral health and facility settings. Each has Texas-specific details worth knowing.

Behavioral and mental health

Behavioral health billing in Texas often means Medicaid managed care, where behavioral health benefits may be handled by the MCO or a behavioral health vendor with its own authorization rules. Since January 1, 2024, Medicare also enrolls marriage and family therapists and mental health counselors, which matters for LPCs and LMFTs. Our mental health billing for Texas practices covers psychiatry, psychology, counseling, substance use treatment and ABA; see behavioral health billing.

Therapy and rehab

Physical therapy billing in Texas involves Medicare's timed-code rules and therapy modifiers, Medicaid MCO authorization for therapy visits, and workers' compensation cases under DWC rules. We handle PT, OT and speech therapy claims; see physical therapy billing.

Physician specialties and facilities

We also bill for internal medicine, pediatrics, OB/GYN, orthopedics, pain management, cardiology, urgent care and other physician specialties, plus ambulatory surgery centers, home health and hospice, EMS agencies and freestanding emergency medical care facilities, which Texas licenses separately from hospitals.

How to compare medical billing companies in Texas

When you compare medical billing companies in Texas, ask questions that show how a team handles Texas payers, not just how it handles claims in general.

1. Can they show how they track TMHP and MCO filing deadlines and the 95-day limits for state-regulated plans?
2. Do they separate fully insured plans from self-funded plans when following up on late payments?
3. Who handles Texas Medicaid enrollment and MCO credentialing, and how is progress reported?
4. Will they work inside your EHR/PM system, and will you keep full access to your data?
5. Will they sign a Business Associate Agreement before accessing PHI?
6. What reporting will you get each month, and who is your point of contact?

Fastora signs a BAA before accessing PHI, and our workflows are aligned with HIPAA and HITECH, with encryption, secure server environments, strict access controls and regular internal audits.

Where we work: Austin, Dallas-Fort Worth, Houston

Fastora is based in Austin and serves practices statewide by secure remote access. Our Texas pages explain local payer and regulatory details for each region: billing support in Austin and Central Texas, billing for Dallas-Fort Worth practices and billing for Houston clinics, EDs and ASCs.

Onboarding is the same wherever you are: a free billing assessment of your claims and AR, a signed BAA, user access to your EHR/PM system, and a kickoff call with your dedicated account contact. Enquiries get a reply within one business day.

Local detail by metro: Austin medical billing services, Dallas medical billing services and Houston medical billing services. We serve practices across Texas, including medical billing services in San Antonio.