Medical specialties
Primary and family care
Surgical and procedural
Dental, DME and labs
Revenue cycle · one rate
Front end · before the visit
Patients, insight and growth
Clinical documentation
Revenue operations
Voice automation
Texas medical billing services · Medicare · Medicaid · Commercial
PhysiAssist bills Texas claims to the rules that decide when you get paid: Novitas Medicare, the Texas Medicaid 95-day filing limit, the Texas prompt-pay clock and the state out-of-network dispute process. Coding, claim submission, payment posting, denials and AR follow-up, with a free audit of your recent Texas claims.
Texas clocks we track on every claim
Texas deadlines
| Clock | Rule | What we do |
|---|---|---|
| Texas Medicaid filing | Most claims must be received within 95 days of the date of service (1 Tex. Admin. Code §354.1003). | Track the filing date per claim and submit well inside the limit. |
| Texas Medicaid appeal | Appeals must be received within 120 days of the last denial or adjustment. | Queue the appeal as soon as the denial posts. |
| Medicaid claim finalization | Claims must be finalized within 24 months of the date of service. | Work open claims to a final status instead of leaving them pending. |
| Prompt pay, electronic claims | A contracted carrier must pay or respond within 30 days of an electronic claim (per the Texas Medical Association). | Calendar the due date and flag late payment. |
| Prompt pay, paper claims | 45 days for a claim submitted on paper. | Submit electronically so the shorter 30-day clock applies; follow up on any paper claim before day 45. |
| Late-payment penalty | 1 to 45 days late: half the difference between billed and contracted rate, up to $100,000. 46 to 90 days late: all of that difference, up to $200,000. 91 or more days late: the same plus 18 percent annual interest. | Flag late and underpaid claims for follow-up against the contract. |
| Out-of-network dispute | On covered plans, a request can be filed 20 to 90 days after the first claim payment, and the provider and plan split the arbitrator cost equally. | Flag the window on every out-of-network claim. |
Sources: 1 Tex. Admin. Code §354.1003, Texas Medical Association prompt-pay guidance, Texas Department of Insurance. Managed care Medicaid plans can set contracted deadlines of their own, and prompt-pay terms depend on your carrier contract, so we confirm both per plan. This is billing information, not legal advice.
Texas payers
| Payer | What to know | What we do |
|---|---|---|
| Medicare Part B | Texas is in Medicare Jurisdiction H, administered by Novitas Solutions (with Arkansas, Colorado, Louisiana, Mississippi, New Mexico and Oklahoma). | Check claims against Novitas policies before submission; work denials and appeals through the Novitas process. |
| Texas Medicaid and CHIP | Fee-for-service claims run through TMHP; managed care plans add their own contracted rules. The 95-day filing limit applies to most claims. | Bill inside the limit, confirm the plan, and track each plan own deadlines. |
| State-regulated commercial plans | ID cards show DOI or TDI. Texas prompt-pay rules and surprise-billing protections apply. | Calendar payment due dates and flag late or underpaid claims. |
| ERS and TRS plans | State employee and teacher plans are covered by the Texas surprise-billing protections. | Apply the state dispute process where it covers the claim. |
| Self-funded employer plans | Texas surprise-billing law does not cover them, and Medicare is outside it as well. | Route out-of-network disputes through the federal process instead. |
What is included
Certified coders code each chart to the payer rules, with a 24-hour chart turnaround and 99% coding accuracy on monthly internal audits.
Clean claims out the door the day charges post, checked against Medicare, Medicaid and commercial edits.
Payments posted against contracted rates; denials worked and appealed inside the Texas windows above.
Aging claims worked by payer and age, with late and underpaid claims flagged against prompt-pay terms.
Pricing is 2.8% to 5% of net collections, depending on specialty mix, claim volume, payer mix and how clean your current process is. The rate covers coding, claim submission, payment posting, denials and AR follow-up. Front desk, prior authorization, the reporting dashboard, patient statements, credentialing and digital marketing are quoted separately. See pricing.
Specialties
Also see denial management, medical coding and end-to-end revenue cycle management.
Under the Texas prompt-pay rules summarized by the Texas Medical Association, a contracted carrier must pay or respond within 30 days of an electronic claim and 45 days of a paper claim. If it pays late, it owes a penalty on top of the contracted rate that grows in three tiers: 1 to 45 days late, 46 to 90 days late, and 91 or more days late, which also adds 18 percent annual interest. Terms depend on your carrier contract, and we calendar each claim against its due date.
Most Texas Medicaid claims must be received within 95 days of the date of service, appeals within 120 days of the last denial or adjustment, and claims must be finalized within 24 months of service (1 Tex. Admin. Code §354.1003). Some situations have longer limits, such as 365 days for certain claims, and managed care plans can set contracted deadlines of their own, so we confirm the plan before a claim is held.
Novitas Solutions is the Medicare Administrative Contractor for Jurisdiction H, which covers Texas, Arkansas, Colorado, Louisiana, Mississippi, New Mexico and Oklahoma, according to CMS. We check claims against Novitas policies before they are submitted.
No. It covers state-regulated plans (look for DOI or TDI on the ID card) plus ERS and TRS plans. It does not cover self-funded employer plans or Medicare. On covered plans, an out-of-network provider can request independent dispute resolution between 20 and 90 days after the first claim payment, and the provider and plan split the arbitrator cost equally. We flag that window on out-of-network claims.
No. Billing runs remotely through your EHR, clearinghouse and payer portals, and the payer rules come from where your practice and patients are, not from where the billing team sits.
PhysiAssist charges 2.8% to 5% of net collections, depending on specialty mix, claim volume, payer mix and how clean your current process is. The rate covers coding, claim submission, payment posting, denials and AR follow-up. Front desk, prior authorization, the reporting dashboard, patient statements, credentialing and digital marketing are quoted separately.
A certified coder reviews a sample of your recent Texas claims for coding, timely-filing risk, denials and underpayments, and sends a written report you keep.
A free Texas billing audit by a certified coder, with a written report you keep.