Texas State Capitol in Austin framed by a teal outline of Texas

Medical Billing Services for Texas Healthcare Practices

Reduce denials, recover lost revenue, and stay compliant. Dastify Solutions, a Texas company, delivers expert Texas medical billing with experienced billers and deep payer knowledge across Medicaid, Medicare, and major commercial insurers.

AAPC & AHIMA-credentialed coding lead CMS & Federal Compliance Texas Insurance Code §1301 & §843 Compliant 28 TAC Chapter 21, Subchapter T Knowledge

Top Challenges that Affect The Performance of Medical Practices in Texas

Denials, missing documentation and delayed follow-up can leave insurance balances unresolved. We review the practice’s payer mix and A/R inventory to identify next actions and establish a reporting baseline.

  • Claim denial and rejection rates can vary by payer, claim type, and practice.

  • 19% of in-network claims were denied, according to KFF's analysis of Marketplace plan data

  • Front-desk and administrative tasks can consume significant staff time and resources in medical practices.

Texas Payer and Filing Requirements

Texas billing requirements depend on the payer, plan, claim type and service. During workflow setup, we identify the applicable submission, appeal and payment rules for the practice’s payer mix. Texas Department of Insurance guidance and TMHP provider resources should be checked alongside the payer’s current requirements.

Texas MCO (Managed Care Organization) Billing

Texas Medicaid operates through MCOs including Superior HealthPlan, Amerigroup Texas, Molina Healthcare of Texas, UnitedHealthcare Community Plan, and Texas Children’s Health Plan.

Dastify Solutions keeps your medical practice fully compliant and profitable.

  • Billing Automation – integrated with clearinghouse edits & payer rules

  • Real-Time Tracking - Monitor claims and payments in real time.

  • Texas Law Compliance – Stay transparent under the Surprise Billing Law.

Serving Providers Across Texas

We understand that local expertise matters in medical billing. At Dastify Solutions, we bring Texas-focused solutions to practices of all sizes, ensuring accuracy, compliance, and faster reimbursements.

Houston

San Antonio

Austin

Fort Worth

El Paso

Arlington

Corpus Christi

Plano

Lubbock

Medical Billing Solution Built Exclusively For Practices in Texas

Our billing company in Texas completely understands that running a medical facility is no easy task. We manage complex payer nuances to keep up with evolving compliance regulations and ever-evolving reimbursement models. These constant changes cause medical practices across Texas to face several revenue challenges, making it difficult to maintain financial stability.

With Dastify Solutions by your side, your practice gains structured billing controls, ongoing workflow support, and a team committed to staying current. Our medical coding experts receive continuous in-house training on relevant coding updates, payer requirements, and state-specific policies that affect the specialties we serve.

Compliance remains a shared responsibility based on your practice’s obligations, payer requirements, and the contracted scope of services.

Dallas practice team billing meeting

We provide the best medical billing solutions in Texas under industry standards, including:

  • Texas Prompt Payment Law

  • No Surprise Billing Law

  • Timely Filing Requirements

  • Clean Claims Requirements

  • HIPAA Compliance & PHI Security

  • Medical Necessity & Accurate Coding

  • Patient Transparency & Good Faith Estimates

  • Medical Records Retention & Disclosure

  • Medicare & Medicaid-Specific Billing Rules

  • HHSC (Health and Human Services Commission) Rules

  • Custom reports for practice insights

Stay Protected From Costly Legal Penalties & HIPAA Violations

Healthcare data breaches exposed millions of individuals across the United States in 2024, highlighting the importance of protecting patient information.

Your patients deserve better protection of their data.

We support documented billing controls and compliance processes; compliance remains a shared responsibility based on the practice’s obligations, payer requirements, and contracted scope of services. We safeguard every piece of Protected Health Information (PHI) with industry-grade security and proactive compliance systems.

AES-256 Encryption

MFA for Secure Access

We work within client-approved EHR systems

Support available security monitoring controls

Support available HL7/FHIR exchange workflows

Compliance with CMS and TMHP Security Guidelines

Protect your Billing Today!

Book 1-on-1 Demo

Medical billing and RCM support for Texas practices

Choosing the right medical billing partner is as essential as a heartbeat. Your practice revenue flow, reputation, patient satisfaction, and claim success rate are all directly connected to your Texas medical billing company. It’s like a make-or-break for your medical facility. That’s why we are the best choice for providers in Texas. We use layered claim checks and human review to help reduce preventable billing errors; results depend on documentation quality and payer requirements. We provide results that truly matter for medical physicians in Texas complete revenue cycle management.

Need tailored or stand-alone medical billing services in Texas? We have you covered!

End-to-End Revenue Cycle Management (RCM)→ Texas-specific payer rules, TMHP, Medicaid MCOs

Insurance Eligibility Verification → Real-time EDI (270/271) checks

Prior-Authorization Services → Texas payer guidelines, medical necessity criteria

Medical Billing & Coding → CPT/ICD-10, HCPCS, NCCI edits

Claim Submission & Scrubbing Services → EDI 837 + clearinghouse edits

Payment Posting → ERA 835 processing

AR Recovery & Denial Management → Texas denial trends such as CO-16, CO-50, PR-49

Credentialing Services → Medicare, Medicaid, BCBS TX, Superior HealthPlan, Amerigroup, MCO enrollment

Want Seamless EHR Integration without disrupting your workflow?

Integrate effortlessly with leading EHR platforms like eClinicalWorks, Athena Health, and NextGen without downtime or data loss.

Here are some major roadblocks:

  • HL7 / FHIR-ready workflow
  • PMS optimization for Texas Medicaid & TMHP
  • Real-time demographic verification to reduce rejections
TebraRXNT
NextGen HealthcarePractice Fusion
athenahealthPractice EHR
DrChronoCentralReach
Kareoathenahealth
CureMDTebra
Dastify Solutions

Why Physicians in TX Trust Dastify Solutions?

We set the benchmark for Outsourced Medical Billing in Texas, delivering precision, speed, and specialty-focused expertise. Our dedication to excellence and attention to detail make us the go-to billing partner for practices nationwide.

We measure our success by yours; that’s why we focus on keeping your numbers higher. And for that, our professional medical billing coders in Texas make a constant effort.

What Dastify Solutions focuses on:

  • Texas payer-specific regulations

  • TMHP documentation accuracy

  • Managed Care Organization (MCO) requirements

  • Local Medicare coverage policies

  • Professional Billers

  • Serving in multiple States

  • BBB Accredited

  • Covering 50+ Specialties

Don’t Let Texas Medicaid Nuances Cost You Revenue

Texas Medicaid rules can be tough, but not when you have the right partner.

TMHP Claim Submission Rules:

We master every TMHP requirement so your claims move smoothly and get paid faster.

Texas Prior Authorization Policies:

Our experts stay ahead of policy changes to prevent costly denials.

MCO Billing for Medicaid & CHIP:

From complex Managed Care Organization rules to documentation accuracy, our professional handles everything without any hassle.

Telehealth & HHSC Reimbursements:

We keep your virtual and remote monitoring claims compliant with the latest HHSC updates.

Stay compliant, and profitable with us. We simplify the process, eliminate errors, and help your practice get every dollar it deserves.

Find Billing Support for Your Texas Specialty

Specialty-Focused Billing Expertise Across Texas.

From Austin to West Texas, see how we bill your specialty.

Choose Your Specialty

We Work With all Major Texas Medicaid MCOs:

  • Superior HealthPlan

  • Amerigroup Texas

  • Molina Healthcare of Texas

  • UnitedHealthcare Community Plan

  • Texas Children's Health Plan

We track PA requirements across STAR, STAR+PLUS, STAR Health, STAR Kids, and CHIP programs.

FAQs.

What is the Texas 95-day claim filing deadline, and how do you ensure compliance?

Under TMHP rules, claims must be received within 95 days from the date of service (or date of discharge for inpatient stays). Missing this deadline means Texas Medicaid will not pay the claim period. Dastify Solutions uses automated tracking to flag claims approaching the 60-day mark, ensuring submission with ample buffer time.

Do you handle Texas Medicaid MCO billing?

Yes. Texas operates Medicaid primarily through managed care organizations (MCOs). We handle billing for all major Texas Medicaid MCOs including Superior HealthPlan, Amerigroup Texas, Molina Healthcare of Texas, UnitedHealthcare Community Plan, and Texas Children’s Health Plan.

What happens if a Texas payer doesn't pay my claim on time?

Under the Texas Prompt Pay Act, payers who fail to pay clean claims timely face significant penalties:

  • Within 45 days late: Lesser of $100,000 or 50% of difference
  • 46-90 days late: Lesser of $200,000 or 100% of difference
  • 91+ days late: $200,000 or 100% PLUS 18% annual interest
How do you handle prior authorizations for Texas payers?

We handle the entire PA process including submitting requests with complete clinical documentation, tracking status and expiration dates, appealing denials, and maintaining compliance with HHSC’s PA timelines (72-hour urgent, 3-day expedited, 14-day standard).

Written by Stephanie Jason
Reviewed by Anum Naveed Director of Compliance
Last updated