Medical Billing Services in Texas
Texas is one of the least forgiving states in the country to bill in. Texas Medicaid gives you just 95 days from the date of service to file — one of the shortest windows anywhere — and with the state's managed care programs (STAR, STAR+PLUS, STAR Kids) each MCO layers its own edits on top of TMHP's. The flip side: the Texas Prompt Pay Act is one of the strongest provider-protection laws in the US, with penalties reaching 18% annual interest on late-paid clean claims. Practices that know how to use it get paid faster in Texas than almost anywhere. We bill for Texas providers from solo family medicine offices in rural counties to multi-specialty groups in the big metros.
Texas Medicaid: filing rules that decide whether you get paid
Administered by the Texas Health and Human Services Commission (HHSC)
Texas Medicaid claims run through TMHP (Texas Medicaid & Healthcare Partnership). Fee-for-service claims must be received within 95 days of the date of service; appeals get 120 days from the R&S (Remittance and Status) date. Most Texas Medicaid members are in managed care — STAR (families and children), STAR+PLUS (aged and disabled, includes LTSS), STAR Kids and CHIP — and the MCOs (Superior, Amerigroup, Molina, Community Health Choice, Texas Children's Health Plan among them) generally mirror the 95-day window but apply their own claim edits and prior-auth lists. Provider enrollment and revalidation run through the PEMS portal.
Deadlines for every major payer — including Texas Medicaid — live in our timely filing limits tool, with an interactive deadline checker.
The payers we bill every day in Texas
Texas billing rules that move real money
Texas Prompt Pay Act (TIC §843.338, §1301.103)
Carriers must pay clean claims within 30 days if submitted electronically and 45 days on paper. Late payment penalties scale with the delay — a clean claim paid 91+ days late owes the contracted rate plus a penalty of up to the billed-charge difference (capped at $200,000) plus 18% annual interest. Few billing teams actually track and invoice these penalties; we do.
95-day statutory filing deadline (TIC §1301.102, §843.337)
Texas-licensed providers must submit claims to managed care carriers within 95 days regardless of contract status — miss it and the right to payment is forfeited unless a catastrophic event applies. Contracts can lengthen this window but never shorten it.
Where we work in Texas
We support practices across the state remotely — same-day claim submission and a dedicated team regardless of your zip code. The markets we serve most:
Credentialing & enrollment in Texas
Physician licensing in Texas runs through the Texas Medical Board, and payer enrollment is its own workstream on top of it — state Medicaid enrollment, CAQH upkeep, and individual plan contracting each on their own timeline. Our credentialing service manages the full stack for Texas providers, and our credentialing calculator estimates realistic timelines by payer.
Texas billing FAQs
What is the timely filing limit for Texas Medicaid?
95 days from the date of service for fee-for-service claims submitted through TMHP. Appeals must be filed within 120 days of the R&S date. Texas Medicaid MCOs (Superior, Amerigroup, Molina and others) generally mirror the 95-day window, but always verify the specific plan manual.
How fast must insurers pay claims in Texas?
Under the Texas Prompt Pay Act, clean claims submitted electronically must be paid by the 30th day after receipt, and paper claims by the 45th day. Late payments accrue penalties that can include 18% annual interest — providers can and should invoice these penalties.
Do you handle Texas Medicaid managed care (STAR, STAR+PLUS)?
Yes. We work claims across TMHP fee-for-service and the major Texas MCOs, including Superior HealthPlan, Amerigroup, Molina, Community Health Choice and Texas Children's Health Plan, and we track each plan's prior-auth and edit differences.
Can you handle provider enrollment with Texas Medicaid?
Yes — Texas Medicaid enrollment and revalidation run through TMHP's PEMS portal, and we manage PEMS applications, revalidations and group linkages as part of our credentialing service alongside commercial payer enrollment.
Medical billing services in other states
Ready to stop losing revenue in Texas?
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