Medical Billing Services in Texas
As a remote-first medical billing company serving Texas practices statewide, MedPrecision pairs TX-specific payer expertise with AAPC-certified billing experts. Texas draws its prompt-pay line at how the claim was submitted, not at the plan label: Insurance Code 843.338 for HMOs and 1301.103 for preferred provider benefit plans both require a determination by the 30th day after receipt for an electronically submitted clean claim and the 45th day for a non-electronic one — the rule that shapes every clean-claim workflow for Texas practices. Blue Cross Blue Shield of Texas anchors Texas's commercial payer mix, which means fee-schedule mastery and timely appeals are non-negotiable for practices operating in the state. Texas Medicaid wants the claim within 95 days of each date of service (out-of-state providers get 365), while commercial deadlines are set by the provider contract and run from roughly 90 days to a full year — deadlines that discipline every claim queue we manage. Our remote billing team builds Texas-specific workflows around these rules, with payer-level edits, MCO portal automation, and appeals templates tuned to how Texas plans actually adjudicate.
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The Texas Billing Landscape
Texas has the largest uninsured population in the nation and has not expanded Medicaid under the ACA, creating a challenging revenue environment for practices statewide. Texas Medicaid operates through STAR, STAR+PLUS, and STAR Kids programs administered by MCOs including Superior HealthPlan (Centene), Molina Healthcare, UnitedHealthcare Community Plan, Amerigroup, and Community Health Choice. Each MCO has region-specific contracts and different prior authorization requirements. Blue Cross Blue Shield of Texas is the dominant commercial payer, followed by UnitedHealthcare, Aetna, Cigna, and Humana. Texas prompt pay turns on submission format rather than plan type: Insurance Code 843.338 for HMOs and 1301.103 for preferred provider benefit plans both set the 30th day after receipt for electronically submitted clean claims and the 45th day for non-electronic ones, with a tiered penalty under 843.342 and 1301.137 that adds 18 percent annual interest once payment slips past the 91st day (verified 17 September 2026). SB 1264 pioneered state-level surprise billing protections before the federal No Surprises Act. The state's enormous geography means practice environments vary dramatically — Houston's Texas Medical Center is the world's largest medical complex, while West Texas and the Rio Grande Valley face severe provider shortages and high uninsured rates. Texas mandates telehealth parity under SB 1107, and Medicaid covers telehealth including audio-only visits. The Dallas-Fort Worth, Houston, San Antonio, and Austin metros each have distinct payer mixes and health system dynamics. Urgent care runs on a tighter clock than the rest of this: Texas Medicaid wants the claim in hand within 95 days of the date of service rather than the 12 months Medicare allows, and POS 20 versus POS 11 changes what the visit pays — the two constraints Texas urgent care billing services is built around.
Who We Serve in Texas
Our Texas client mix skews toward solo practices, group practices, federally qualified health centers , plus rural health clinics and telehealth providers. We work with providers in Houston, Dallas, San Antonio and across the rest of the state, all remotely.
Major Metros Served
What billing costs in Texas
We publish one national rate card and bill Texas practices on exactly the same terms as everywhere else — there is no regional markup and no quote-only tier below enterprise. You pay a percentage of what we actually collect, so if we do not collect, you do not pay.
| Practice size | Rate | Basis | Note |
|---|---|---|---|
| Solo practice | 7.0% | of monthly collections | Monthly minimum applies |
| Group practice | 6.0% | of monthly collections | Volume discounts available |
| Enterprise | Custom | tiered pricing | Scoped per engagement |
- No setup or implementation fee
- No per-claim charge
- No software fee and no markup on third-party costs — clearinghouse fees, postage and payer application fees are passed through at cost
- 12-month initial term, then month-to-month — 60 days' notice either way, no early-termination penalty
Payer Landscape in Texas
Texas Medicaid (STAR, STAR+PLUS, STAR Kids) routes members through Superior HealthPlan, Molina Healthcare, UnitedHealthcare Community Plan and 2 more plans, each with its own authorization rules and fee schedule. On the commercial side, Blue Cross Blue Shield of Texas, Aetna, UnitedHealthcare drive the bulk of Texas claim volume, so we maintain payer-specific denial playbooks and appeal templates for each. Claim clocks in Texas run 95 days for Medicaid and 90-365 days for commercial payers — deadlines our A/R queues are built around. Texas's prompt-pay statute: Texas Insurance Code 843.338 (HMOs, Chapter 843 Subchapter J) and 1301.103 (preferred provider benefit plans, Chapter 1301 Subchapter C) both require a determination on a clean claim not later than the 30th day after receipt for an electronically submitted claim and the 45th day for a non-electronic claim. The deadline turns on submission format, not on whether the plan is an HMO or a PPO. Sections 843.342 and 1301.137 set the late-payment penalty: the lesser of 50 percent of the difference between billed charges and the contracted rate or $100,000; the lesser of 100 percent of that difference or $200,000 when the claim is paid on or after the 46th day and before the 91st day; and that penalty plus 18 percent annual interest when it is paid on or after the 91st day. Electronically submitted pharmacy claims run a shorter clock under 843.339. Verified against the Texas Insurance Code as published by the Texas Legislature on 17 September 2026.
Medicaid Program
Texas Medicaid (STAR, STAR+PLUS, STAR Kids)
Managed Care Organizations
Key Commercial Payers
Timely Filing Deadlines
Prompt Pay Law
Texas Insurance Code 843.338 (HMOs, Chapter 843 Subchapter J) and 1301.103 (preferred provider benefit plans, Chapter 1301 Subchapter C) both require a determination on a clean claim not later than the 30th day after receipt for an electronically submitted claim and the 45th day for a non-electronic claim. The deadline turns on submission format, not on whether the plan is an HMO or a PPO. Sections 843.342 and 1301.137 set the late-payment penalty: the lesser of 50 percent of the difference between billed charges and the contracted rate or $100,000; the lesser of 100 percent of that difference or $200,000 when the claim is paid on or after the 46th day and before the 91st day; and that penalty plus 18 percent annual interest when it is paid on or after the 91st day. Electronically submitted pharmacy claims run a shorter clock under 843.339. Verified against the Texas Insurance Code as published by the Texas Legislature on 17 September 2026.
Texas Billing Regulations & Compliance
The Texas Department of Insurance (TDI) sets the rules our Texas billing workflows have to satisfy. Surprise billing in Texas: Texas SB 1264 protects patients from surprise medical bills for out-of-network emergency care and certain facility-based services, effective since 2019. Telehealth parity: Texas requires private insurers to reimburse telehealth services at the same rate as in-person visits under SB 1107. Medicaid also covers telehealth with audio-only options.
State Insurance Regulator
Texas Department of Insurance (TDI)
Surprise Billing Protection
Texas SB 1264 protects patients from surprise medical bills for out-of-network emergency care and certain facility-based services, effective since 2019.
Telehealth Billing Parity
Texas requires private insurers to reimburse telehealth services at the same rate as in-person visits under SB 1107. Medicaid also covers telehealth with audio-only options.
Common Questions
Common questions about medical billing services in Texas.
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Get a Free Billing AuditHow do you handle Texas Medicaid MCO billing?
Texas Medicaid is managed through multiple MCOs including Superior, Molina, and UnitedHealthcare Community Plan. Each has different prior auth rules and timely filing windows. Our team tracks payer-specific requirements for each MCO your practice contracts with.
Do you work with practices outside major Texas metros?
Yes. We work with practices in Dallas, Houston, San Antonio, Austin, and El Paso, as well as rural practices across the state. Our remote model provides the same level of support regardless of location.
How do Texas prompt pay laws affect collections?
The distinction the statute draws is electronic versus non-electronic submission, not HMO versus PPO. Insurance Code 843.338 (HMOs) and 1301.103 (preferred provider benefit plans, which covers PPO and EPO products) both give the payer until the 30th day after receipt for an electronically submitted clean claim and the 45th day for a non-electronic one. Filing electronically is therefore worth 15 days of cash flow on every claim. We submit clean claims electronically, track them against the right clock, and appeal when a payer misses it. Verified against the Texas Insurance Code as published by the Texas Legislature on 17 September 2026.
What specialties do you support in Texas?
We work with mental health practices, physical therapy clinics, family medicine groups, urgent care centers, cardiology practices, and orthopedic groups across Texas. Each specialty gets a billing team familiar with its codes and payer rules.
What happens if a payer misses the Texas prompt-pay deadline?
Texas Insurance Code 843.338 (HMOs) and 1301.103 (preferred provider benefit plans) both require a determination on a clean claim by the 30th day after receipt when it was submitted electronically and the 45th day when it was not — the line is submission format, not plan type. Miss it and Sections 843.342 and 1301.137 impose a tiered penalty: the lesser of 50 percent of the difference between billed charges and the contracted rate or $100,000; the lesser of 100 percent of that difference or $200,000 if the claim is paid on or after the 46th day and before the 91st; and that larger penalty plus 18 percent annual interest once the claim is paid on or after the 91st day. We track every clean claim against the right clock, flag stalled payments in our A/R reports, and escalate to the Texas Department of Insurance (TDI) when a payer defaults. Texas Medicaid claims must reach TMHP within 95 days of each date of service; commercial deadlines are contractual. Verified against the Texas Insurance Code and the Texas Medicaid Provider Procedures Manual on 17 September 2026.
How do I choose a medical billing company in Texas?
Prioritize a billing company that already works with Texas Medicaid and the major commercial payers in Texas — payer-specific edits and timely-filing windows are where most TX revenue leaks start. Ask about AAPC-certified coders, transparent pricing, and denial-rate and days-in-A/R reporting before you sign. Because billing is delivered remotely, a company's Texas payer experience matters more than a local office address.
Services for Texas practices
Specialties we bill for
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Billing help for your Texas practice
Tell us the specialty and we will come back on what your Texas payer mix actually changes — filing windows, the state's prompt-pay clock, and which plans your claims are going to. Written findings in 3–5 business days.
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Services in Texas
Specialties in Texas
Other Locations We Serve
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See where denials, follow-up delays, or workflow gaps may be hurting your Texas practice's collections.
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