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Medical billing services
in Texas
Qualigenix bills Texas Medicaid, Medicare and commercial payers for independent practices, and files every claim inside the payer's deadline.
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How Qualigenix serves Texas practices
Qualigenix bills for independent practices in Austin, Houston, Dallas and San Antonio, and in smaller Texas markets too. We bill all payers. A typical Texas practice sends claims to three very different systems in a single week: Texas Medicaid and its STAR health plans, Medicare through Novitas Solutions, and commercial plans that follow the state's prompt-pay rules. Each system runs on its own clock. Texas Medicaid wants claims within 95 days. Commercial plans regulated by the state also want them within 95 days, then have 30 days to pay a clean electronic claim. Medicare runs through its own contractor with its own coverage policies. Qualigenix sets up each payer's rules in your billing workflow before the first claim goes out. We work inside your existing EHR. You don't change software, and your staff doesn't learn a new system. You get one billing team, one point of contact, and a monthly report that shows where every dollar sits.
What medical billing services does Qualigenix provide in Texas?
Qualigenix handles the full billing cycle for Texas practices: coding, charge entry, claim scrubbing and submission, denial management, A/R follow-up and patient statements.
We bill all payers, including Texas Medicaid and its managed care plans, Medicare through Novitas Solutions, and commercial plans. Claims are tracked against each payer's filing window, so none age out.
Texas medical billing problems we solve
Texas practices lose money in four places: Medicaid's short filing window, commercial claims that stall without follow-up, Medicare claims that miss coverage rules, and patient bills that break the state's balance-billing limits. Qualigenix built a workflow for each one.
Texas Medicaid claims filed on time, every time
Texas Medicaid expects claims within 95 days of each date of service, and every claim has to be finalized within 24 months. That's a tight window. Most Texas Medicaid patients are enrolled in managed care, through STAR, STAR+PLUS, STAR Kids or STAR Health, so the claim has to reach the right health plan too. Qualigenix checks eligibility and plan assignment before the claim is built, then tracks each Medicaid claim by date of service with a filing deadline attached. If a plan rejects a claim, we fix and resubmit it while time is left.
Commercial claims tracked to payment
State-regulated HMO and PPO plans in Texas expect claims within 95 days of service. Once a clean claim arrives electronically, the plan has 30 days to pay or deny it, or 45 days for a paper claim. If the plan audits the claim, it still has to pay the full contracted rate first. Qualigenix files electronically, logs each acknowledgment, and starts follow-up the day a payment window closes. We don't send duplicate claims before the window ends, because Texas rules bar them. For secondary claims, we file within 95 days of the primary payer's decision.
Medicare claims built for Texas's Medicare contractor
Novitas Solutions processes Original Medicare Part A and Part B claims for Texas as the contractor for Jurisdiction H. CMS awarded Novitas a new contract for the jurisdiction in June 2026. Novitas publishes local coverage determinations that decide which diagnoses support which procedures. Qualigenix checks each Medicare claim against those coverage policies before it goes out, so claims don't come back denied for medical necessity. When Novitas changes a policy, we update the claim edits for your specialty.
Patient statements Texas patients can trust
Texas bars balance billing for patients on state-regulated plans in emergencies, and at in-network facilities when the patient didn't choose the provider. Those plans carry "DOI" or "TDI" on the member ID card. Qualigenix checks the card before a patient statement goes out. When a payment dispute falls under the state rules, the practice can request arbitration through the Texas Department of Insurance instead of billing the patient. Self-funded employer plans and Medicare fall under federal surprise billing rules, and we apply those instead. We don't balance bill Texas Medicaid patients for covered services.
RESULTS ACROSS 275+ PRACTICES
Results Texas practices can expect
These are company-wide Qualigenix results across all clients and states, not Texas-only figures.
98.2%
First-pass clean claim rate
4.8%
Denial rate
97.7%
Net collections rate
Reduced from 54 to 36
Days in A/R
79%
Denials overturned
Under 9 days
Appeal turnaround
$923M+
Revenue recovered
PROVEN TRACK RECORDHIPAA-Compliant Revenue Cycle
275+ ClinicsGETTING STARTED
How onboarding works
Qualigenix takes a Texas practice live in 6 days on average. Here's how it runs.
01
Discovery call
We review your specialty, payer mix, claim volume and current A/R so the setup matches how your practice bills today. We also flag claims already close to a filing deadline.
02
System access
You grant us access to your EHR and clearinghouse. We work inside the systems you already use, so your staff keeps the same tools. Access is limited to the team assigned to your account.
03
Payer setup
We load each payer's rules: Texas Medicaid and STAR plan filing windows, Novitas coverage edits, and commercial payment timelines. Your fee schedules are loaded so underpayments get caught.
04
Go-live
New claims start going out under Qualigenix, and we pick up open A/R from your prior billing team or vendor.
05
Monthly reporting
You get a report each month showing collections, denials and A/R by payer.
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WHY PRACTICES CHOOSE QUALIGENIX
Why Texas practices choose Qualigenix
Texas practices pick Qualigenix for four reasons.
Specialty-assigned coders
Your claims go to coders who work in your specialty every day. They know which modifiers your payers expect, and they keep coding accuracy at 98.9%. When documentation won't support a code, they tell the provider before the claim goes out.
Works with any EHR
Qualigenix works inside 133 EMR and EHR platforms. You don't migrate data or retrain staff, and billing starts from the system your providers already chart in. If you change EHRs later, billing moves with you.
Transparent monthly reporting
Every month you see collections, denials, days in A/R and open claims by payer. When a number moves, the report shows which payer moved it. You also see claims nearing a filing deadline before they become write-offs.
6-day average onboarding
Most practices go live in 6 days. Open claims from your prior billing team are picked up during the switch, so cash flow doesn't stop. Your staff keeps seeing patients the whole time.
HAVE QUESTIONS?
Medical Billing in Texas, answered
Frequently asked questions about our setup and support in Texas.
Qualigenix is a medical billing company that serves independent practices across Texas, including Austin, Houston, Dallas and San Antonio. When you compare billing companies, ask for their clean claim rate, net collections rate and how they handle Texas Medicaid's 95-day filing window. Qualigenix reports a 98.2% first-pass clean claim rate across all clients.
Yes. Qualigenix bills Texas Medicaid and its managed care programs, including STAR, STAR+PLUS, STAR Kids and STAR Health. We check each patient's plan assignment before billing, so claims reach the right health plan the first time. We also confirm each rendering provider's Medicaid enrollment is active.
Qualigenix attaches a filing deadline to every claim based on the payer: 95 days from the date of service for Texas Medicaid and for state-regulated commercial plans. Claims near their deadline move to the front of the queue. Rejections are fixed and resubmitted while time remains.
Yes. Qualigenix bills Medicare Part B claims through Novitas Solutions, the Medicare contractor for Texas. Each claim is checked against Novitas coverage policies before submission to cut medical necessity denials. Medicare Advantage claims go to the patient's plan, not Novitas.
Qualigenix bills all payers. That includes Texas Medicaid and its STAR health plans, Medicare through Novitas Solutions, Medicare Advantage plans, and commercial HMO and PPO plans. Talk to a billing specialist to review your payer mix.
Qualigenix charges a percentage of collections, so our fee is tied to what your practice is paid. Your quote covers only the services your practice picks. The rate depends on your specialty, claim volume and services. Request a consultation for a quote based on your practice.
Qualigenix onboards practices in 6 days on average. You don't need to change your EHR or clearinghouse. We pick up open claims from your prior billing team during the switch, so payments keep coming in while new claims start going out.
Yes. Qualigenix is HIPAA compliant and signs a business associate agreement with every client. Patient data is accessed only inside your EHR and clearinghouse, by staff assigned to your account.