Texas is several billing markets in one state. Four major metros, a deep Medicaid managed care roster, high Medicare Advantage penetration, and a large uninsured population all shape the same claim differently depending on where your patient sits. A generic billing workflow misses those differences, and the revenue goes with it.
MedPlus RCM provides medical billing, coding, credentialing, and denial management for Texas practices of every specialty, built around the state’s actual payers and programs.
Texas’s payer landscape
Texas Medicaid runs through managed care programs, STAR, STAR+PLUS, and STAR Kids, delivered by plans that vary by service area, including Superior HealthPlan, Amerigroup (Wellpoint), Molina Healthcare, UnitedHealthcare Community Plan, Community Health Choice, and Community First Health Plans. Billing the right program but the wrong service-area plan returns a denial, so plan and service-area verification before the visit is essential.
Commercial coverage is led by Blue Cross Blue Shield of Texas, alongside UnitedHealthcare, Aetna, Cigna, and Humana. Medicare Advantage prior authorization touches a significant share of schedules in the major metros, and Medicare Part B claims run through the state’s Medicare contractor.
What MedPlus RCM handles for Texas practices
- End-to-end medical billing. Charge entry, claim scrubbing, submission, payment posting, and patient billing, the full cycle.
- Medical coding. Certified coders assign current ICD-10, CPT, and HCPCS codes matched to your documentation and specialty.
- Provider credentialing and enrollment. End-to-end enrollment with STAR plans, commercial payers, and Medicare, plus re-credentialing maintenance.
- Denial management and recovery. Every denial investigated to root cause, corrected, and appealed with documentation.
- A/R recovery. Aged and outstanding balances audited and pursued, including balances already written off where the appeal window is still open.
- Financial reporting. Clean claim rates, collections, denial patterns, and A/R aging visible by payer and provider.
We serve practices statewide, Houston, Dallas-Fort Worth, Austin, San Antonio, Fort Worth, and El Paso, across specialties including primary care, mental and behavioral health, cardiology, orthopedics, dermatology, and physical therapy.
Results Texas practices can check
MedPlus RCM maintains a 99% clean claim rate and keeps client accounts receivable under 30 days. Pricing is a performance-based percentage of successfully collected revenue: if you don’t get paid, we don’t get paid. We are 100% HIPAA compliant, and onboarding takes 2 to 4 weeks depending on practice size, with no disruption to your daily cash flow.
Frequently asked questions
Why is Texas Medicaid billing complicated?
STAR plans vary by service area, so the same patient can belong to a different plan depending on where they live. Verifying the plan and service area before the visit prevents the most common Texas Medicaid denial.
Do you work with Texas STAR plans?
Yes. We bill STAR, STAR+PLUS, and STAR Kids plans including Superior HealthPlan, Amerigroup, Molina, UnitedHealthcare Community Plan, Community Health Choice, and Community First, as well as commercial and Medicare plans.
How long does it take to switch our billing to MedPlus RCM?
Onboarding takes between 2 and 4 weeks depending on practice size, including data migration and payer clearinghouse setup.
What does MedPlus RCM charge?
A performance-based percentage of successfully collected revenue. If you don’t get paid, we don’t get paid.
Get a free financial audit
Find out where your Texas practice is losing revenue. Request a free financial audit and our specialists will review your claims, denials, and A/R.
