Medical Billing Services In Texas
Emerald Health equips large independent physician groups across Houston, Dallas–Fort Worth, Austin, San Antonio, and secondary Texas markets with front-end-first medical billing services. We emphasize real-time eligibility verification and prior authorization capture before the visit, then bill Texas Medicaid fee-for-service through TMHP and STAR, STAR+PLUS, STAR Kids, and STAR Health managed care claims to the correct MCO. Medicare Part A/B for Texas is processed by Novitas Solutions under Jurisdiction H (JH). Commercial panels frequently include Blue Cross and Blue Shield of Texas, UnitedHealthcare, Aetna, Cigna, and Humana. Our revenue cycle management design also respects Texas SB 1264 surprise-billing rules for state-regulated plans, Texas Prompt Pay Act timelines, and Division of Workers’ Compensation fee guidelines so independent practices protect cash without building a bloated in-house billing department.
Years of Experience
16
+
Revenue Collected
$
150
M+
Denial Rate
<
5
%
Client Satisfaction
99
%
Texas Billing Anchored in Eligibility, Prior Auth, TMHP, and STAR Plans
Same-Day Eligibility for TMHP, STAR, and Commercial Plans
Eligibility is verified before every appointment—distinguishing TMHP fee-for-service Medicaid from STAR / STAR+PLUS / STAR Kids / STAR Health MCO assignment and confirming BCBSTX, UnitedHealthcare, Aetna, Cigna, or Humana benefits—so large independent Texas clinics do not discover coverage gaps after the visit.
Multi-Location Payment Posting for Independent Groups
ERA posting across multiple Texas locations keeps payer and patient balances accurate for independent groups that share a tax ID but operate several clinics, highlighting short-pays against contracted BCBSTX and Medicare JH rates.
Auth-Complete Claim Scrubbing Before TMHP & Commercial Submit
Claims leave the practice only after coding, diagnosis pairing, and prior-authorization numbers required by STAR MCOs or commercial utilization management are present—cutting the preventable rejects that dominate Texas independent-practice denial reports.
SB 1264 & Prompt Pay Compliance Monitoring
Workflow reviews watch for SB 1264 balance-billing risks on emergency and certain out-of-network facility services under Texas-regulated plans, Texas Prompt Pay Act clock starts on clean claims, and workers’ compensation documentation gaps that jeopardize DWC fee-guideline payment.
Denial Recovery After Auth and Eligibility Misses
When a claim still denies, we correct eligibility or auth defects, appeal STAR MCO and commercial decisions, and feed root causes back into the pre-visit checklist so the same Texas denial does not recur next month.
Prior-Auth Leakage & Payer-Mix Reporting
Reports quantify dollars lost to missing prior auth, eligibility failures, and STAR versus commercial mix shifts across Houston, DFW, Austin, and San Antonio sites so independent practice leaders can staff the front desk where leakage starts.
Front-Office Discipline for Large Texas Independent Practices
Scheduling & Auth Desk Support
We reinforce scheduling scripts that trigger eligibility and prior-auth tasks for high-risk CPT categories before Texas patients arrive, protecting large independent groups from same-day write-offs.
Documentation That Matches Auth Approvals
Coding guidance keeps procedure and diagnosis codes aligned with the prior authorization on file so STAR and commercial payers cannot deny for code mismatch after the service is done.
Capacity Planning for Multi-Clinic Texas Groups
We evaluate whether eligibility/auth staffing matches visit volume across clinics and recommend queue designs that keep independent Texas groups scalable without a full corporate RCM office.
Modular Billing Support for Growing Independent Practices
Engagements can start with eligibility and prior-auth only, then expand into full claim submission and AR as Texas locations or specialties are added.
Services Emerald Health Offers in Texas
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Medical billing for Houston, DFW, Austin, San Antonio, and statewide independent physician practices.
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Coding support synchronized with Texas commercial and STAR authorization requirements.
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Credentialing help with TMHP Medicaid enrollment, STAR MCOs, Blue Cross and Blue Shield of Texas, and Novitas JH Medicare.
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AR and denial management that feeds failures back into eligibility and prior-auth checklists.
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Eligibility verification and prior authorization management as the primary Texas service emphasis.
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HIPAA-secure billing operations with Emerald Health support from 237A State Road, Dartmouth, MA 02747 — (978) 631-1071.
Talk With Texas Eligibility & Prior-Auth Billing Specialists
If your independent Texas group is losing revenue to eligibility misses and prior-auth denials across STAR and commercial plans, Emerald Health can harden the front end and run claims through TMHP, MCOs, and Novitas JH. Call (978) 631-1071.
Texas Medical Billing FAQ
Texas Medicaid fee-for-service claims and many prior authorizations route through the Texas Medicaid & Healthcare Partnership (TMHP). Most members, however, are in managed care—STAR, STAR+PLUS, STAR Kids, or STAR Health—and must be billed to their MCO under that plan’s rules. Emerald Health verifies TMHP versus STAR assignment before submission so independent practices do not send Medicaid claims to the wrong entity.
Senate Bill 1264 restricts balance billing for emergency care and certain out-of-network services at in-network facilities for Texas Department of Insurance–regulated plans (and specified state employee plans). It generally does not cover Medicare, Medicaid/STAR, or most self-funded ERISA plans. Emerald Health identifies SB 1264 scenarios, prevents improper patient billing, and supports Texas IDR mediation/arbitration documentation when provider–plan payment disputes arise.
Large independent Texas groups generate high daily encounter volume across specialties. Most avoidable denials start before the claim—inactive coverage, wrong STAR MCO, or missing prior auth. Emerald Health staffs eligibility and authorization as primary controls, then submits clean claims, which protects cash flow more effectively than chasing denials after the fact.
Novitas Solutions is the A/B MAC for Jurisdiction H (JH), which includes Texas. Emerald Health files Medicare claims to Novitas JH, monitors remittances, and manages appeals under CMS’s one-calendar-year timely-filing rule while TMHP/STAR and commercial work continue in the same billing program.
Blue Cross and Blue Shield of Texas, UnitedHealthcare, Aetna, Cigna, and Humana dominate many independent-practice panels statewide, each with distinct prior-auth lists and portal tools. Emerald Health configures eligibility transactions, auth tracking, and denial queues around your actual Texas contracts instead of a generic national payer file.