Texas Medicaid
Administered by Texas Health and Human Services Commission (HHSC) through TMHP (Texas Medicaid & Healthcare Partnership) via PEMS (Provider Enrollment and Management System).
Texas Revenue Cycle Management
Medical billing for Texas practices — Texas Medicaid, Medicare, and commercial payers.
Texas's Medicaid billing runs through Texas Health and Human Services Commission (HHSC), and every managed-care plan has its own rules. We bill Texas Medicaid, Medicare, and Texas's commercial payers correctly the first time — and follow every denial through to resolution.
The Texas payer landscape
Managed-care plans
- STAR
- STAR+PLUS
- STAR Kids
Dominant commercial payers
- Blue Cross Blue Shield of Texas
- Cigna
- Aetna [VERIFY]
Why Texas claims get denied
- Wrong STAR, STAR+PLUS, or STAR Kids managed-care plan on file for the member's eligibility category
- PEMS enrollment lapsed and TMHP suspended billing privileges mid-cycle [VERIFY]
- Prior authorization missing for a service that specific STAR managed-care plan requires
- STAR Kids coordination-of-benefits errors between the plan and a member's other coverage
- Behavioral health claims denied for provider type not matching the STAR plan's network category
Texas behavioral health billing
Texas routes behavioral health through the same STAR, STAR+PLUS, and STAR Kids managed-care plans rather than a separate carve-out, so we confirm the member's plan and provider-type network category before submitting to avoid a network-mismatch denial.
Credentialing comes first
TMHP enrollment through PEMS plus separate credentialing with each STAR-family plan you'll bill is the standard Texas sequence — see our Texas credentialing page for the full timeline.
See Texas Credentialing →Billing and books together
Your Texas claims and your bookkeeping are handled by the same team, so collections, denials, and adjustments always tie back to your financials without a reconciliation gap between separate vendors.
Clearinghouses and EHRs we work in
AvailityOffice AllyWaystarTebraAdvancedMDSimplePracticeKipuTheraNestAveaICANotesBestNotes
5–7% of collections · $950/mo minimum — the same in every state.
Free analysis
Free Texas Revenue Leakage Analysis
Send a recent AR aging report and denial summary. We'll show you denial patterns by Texas Medicaid plan, days in AR, and the fixes we'd make first.
Send de-identified reports only — we sign a Business Associate Agreement before any PHI is exchanged.