Texas
Texas is not one payer market. A practice in Houston and a practice in Lubbock deal with different managed care organizations, different referral patterns and different denial habits, and billing that treats them identically produces avoidable write-offs in both.
Enrollment with Texas Medicaid through TMHP is one step; being loaded correctly with each STAR plan a practice actually sees is another, and it is the one that gets missed. A provider can be active with the state and still have claims denied by an MCO that has no record of them. We track both, and we check the MCO roster before a new provider starts seeing patients rather than after the first denials arrive.
Because Texas Medicaid members move between managed care plans, coverage verified last month is not coverage verified today. Eligibility is checked against the current plan before the appointment, which catches the plan changes and the retroactive terminations that otherwise surface as a CO-27 six weeks later, when the filing window is already narrowing.
Practices operating across Dallas–Fort Worth, Houston, Austin and San Antonio often carry several tax IDs and several payer contracts. Claims are separated by location and payer so collections can be read per site, which is the only way to see that one location has a credentialing problem rather than a billing problem.
Most Texas Medicaid members are enrolled in a managed care plan rather than fee-for-service, so the claim goes to the MCO and follows the MCO’s rules, not the state’s. Verifying which plan a patient is in before the visit is the single largest source of avoidable Texas denials we see.
Payers we work in Texas
Not an exhaustive list, and not a claim of network participation on your behalf — your contracts are yours. It is the payer mix we are set up to work in Texas.
Everywhere else
All billing servicesNext step
Send an aging summary and a handful of denials. You get a written read on what is recoverable — no fee, no obligation to sign anything.
