MedStats Billing provides comprehensive billing solutions for Texas’s vast and diverse healthcare market, ensuring accurate coding, fewer denials, and faster reimbursements to maximize your practice’s revenue potential statewide.
Texas is not a state you can bill on autopilot. Medicaid runs through multiple managed care programs — STAR, STAR+PLUS, STAR Kids, and STAR Health — each with its own set of managed care organizations, prior authorization rules, and fee schedules, while traditional fee-for-service claims route through TMHP instead. Add a workers’ compensation system that’s optional for private employers, and Texas billing becomes a landscape where two practices down the street can require completely different claims workflows.
Bullet list:
Built to bring clarity, control, and consistency to your Texas revenue cycle.
MedStats Billing manages everything from credentialing and claims submission to denial resolution, providing complete, results-driven medical billing and RCM solutions for healthcare providers across the United States.
Texas practices lose revenue to problems that don’t look like problems until the denials pile up. These are the four we see most often.
STAR, STAR+PLUS, STAR Kids, and STAR Health each carry their own MCOs, prior authorization rules, and fee schedules by service area. Billing them like one program is a fast route to avoidable denials.
Managed care claims and fee-for-service claims go to different administrators — the member's MCO or TMHP. Claims sent to the wrong one get rejected or delayed, and most practices don't catch it until AR ages.
Texas is the only state where workers' comp coverage is optional. Billing an occupational injury claim without first confirming subscriber status routes it to the wrong payer entirely.
Texas payers must pay or deny a clean claim within 30 days (electronic) or 45 days (paper). Practices that don't track this deadline miss out on penalties and interest they're legally owed.
Payers must pay or deny a clean claim within 30 days if submitted electronically, or 45 days if submitted on paper. We track submission and response timing on every claim so overdue payments don't slip past the statutory deadline unclaimed.
Claims paid outside the required window can trigger financial penalties and 18% annual interest against the payer. We flag and escalate late claims so your practice recovers what it's owed, not just what gets paid voluntarily.
Texas is the only state where workers' comp coverage is optional for private employers. Before billing an occupational injury claim, we confirm whether the employer is a subscriber (billed through standard workers' comp channels) or a non-subscriber (billed through a different pathway entirely), so claims aren't submitted to the wrong payer type from the start.
Texas Medicaid claims don't all go to the same place — managed care claims route to the member's specific MCO, while fee-for-service claims route through TMHP. We verify eligibility and plan type up front so claims aren't misrouted or rejected for going to the wrong administrator.
MedStats Billing provides tailored billing solutions for a wide range of medical specialties, ensuring accurate coding, fewer denials, and faster reimbursements to maximizes your revenue potential.
MedStats Billing manages everything from credentialing and claims submission to denial resolution, providing complete, results-driven medical billing and RCM solutions for healthcare providers across the United States.
Every claim is reviewed against payer rules to minimize rejections and speed reimbursements.
Denied and aging claims are actively tracked, appealed, and followed through until resolution.
Clear reporting on collections, AR aging, and denial trends gives you complete visibility into your overall billing performance.
Our team works Molina, BCBS Texas, and TRICARE claims routinely — so Texas-specific rules and denial patterns are handled, not learned on your dime.
Our billing workflows adapt to independent providers and multi-location groups without disrupting operations.
Secure data handling and controlled workflows help protect patient and practice information at every stage.
We integrate smoothly with widely used EHR platforms to ensure accurate data flow from documentation to claim submission. This reduces manual errors, speeds processing, and supports cleaner reimbursements.
We work alongside leading systems including:
Get a structured review of your current billing process from MedStatsBilling and uncover opportunities to improve claim accuracy, accelerate reimbursements, and gain clearer visibility into your revenue cycle performance.
Texas Medicaid runs through several managed care programs — STAR, STAR+PLUS, STAR Kids, and STAR Health — each with its own set of managed care organizations (like Superior HealthPlan, Amerigroup, Molina, and UnitedHealthcare Community Plan) that vary by service area. Providers must track each plan’s own prior authorization rules, fee schedules, and network requirements.
Under the Texas Prompt Pay Act, HMOs and insurers must pay or deny a clean claim within 30 days if it was submitted electronically, or 45 days if submitted on paper. Claims that miss this window can trigger statutory penalties and interest against the payer.
Yes — significantly. Texas is the only state where workers’ compensation coverage is optional for private employers. Practices treating occupational injuries need to confirm upfront whether the employer is a “subscriber” (billed through standard workers’ comp channels) or a “non-subscriber” (billed differently, often through liability or alternative injury benefit plans), since the billing pathway and payer differ.
TMHP (Texas Medicaid & Healthcare Partnership) administers fee-for-service Medicaid claims under contract with the Texas Health and Human Services Commission. Managed care claims, however, go directly to the member’s MCO — not TMHP — so knowing which pathway applies to a given patient matters for clean claim submission.
Yes — we handle enrollment with Texas Medicaid managed care plans, Medicare via PECOS, and commercial payers, along with CAQH maintenance and re-credentialing deadline tracking so providers stay in-network without gaps.
We support independent practices and multi-location groups across Texas, including Houston, Dallas–Fort Worth, San Antonio, Austin, and surrounding metro and rural service areas.
