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Medical coding services
in Texas
Qualigenix codes every encounter for Texas practices to the rules of the payer who'll see the claim: Texas Medicaid, Medicare through Novitas Solutions, or a commercial plan.
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How Qualigenix serves Texas practices
Qualigenix codes for independent practices in Austin, Houston, Dallas and San Antonio, and for practices across the rest of Texas. We code for all payers, and that's where Texas gets hard. The same well-child visit is coded one way for a commercial plan and another way for Texas Medicaid, which adds its own modifiers, condition indicators and screening codes. A Medicare claim for the same diagnosis has to match the coverage policies Novitas Solutions publishes for Texas. Our coders work by specialty, not by queue. A pediatric practice gets coders who code Texas Health Steps checkups every day. An orthopedic group gets coders who know surgical modifiers and Novitas coverage rules for joint procedures. Coding happens inside your EHR, so providers keep charting the way they do now. Every month you get a coding report: accuracy by provider, the codes payers questioned, and the documentation gaps behind them. Over time, those reports cut the denials that start with a coding error.
What medical coding services does Qualigenix provide in Texas?
provides specialty coding, E/M coding, modifier and NCCI edit review, coding audits, charge capture and coding denial review for Texas practices.
Coders apply Texas Medicaid's state-specific codes and modifiers, Novitas Solutions' Medicare coverage policies, and each commercial payer's published coding rules before a claim leaves your practice.
Texas medical coding problems we solve
Coding errors in Texas show up in four places: Texas Medicaid's state-specific coding rules, Medicare coverage policies, commercial payers' own coding policies, and audits that ask whether the chart supports the code. Qualigenix built a coding check for each one.
Texas Medicaid claims coded to the state's rules
Texas Medicaid adds coding rules that commercial plans don't use. A Texas Health Steps checkup is billed with preventive codes 99381 to 99395, a provider-type modifier for whoever did the exam (AM, SA, TD or U7), and a condition indicator showing whether a referral was made. Autism screening takes modifier U6, and fluoride varnish is coded 99429 with U5. The state's Office of Inspector General has flagged hearing tests billed on the same day as a well-child checkup, since the checkup already includes one. Qualigenix coders apply the current Texas Health Steps guide to every checkup.
Medicare claims matched to Novitas's coverage policies
Novitas Solutions, the Medicare contractor for Texas, publishes local coverage determinations and billing and coding articles in the CMS Medicare Coverage Database. Those articles list which diagnosis codes support medical necessity for a service. If the diagnosis on the claim isn't on the list, Medicare denies it, even when the procedure was correct. Qualigenix coders check the diagnosis-to-procedure match against the current Novitas policy before the claim goes out. When Novitas revises a policy, we update the coding rules for your specialty.
Commercial claims coded to each payer's policies
Commercial payers in Texas publish their own coding and payment rules, and they don't always match CPT guidance or each other. Blue Cross and Blue Shield of Texas, for example, publishes Clinical Payment and Coding Policies on its provider site, built from professional society guidance and CMS criteria. Qualigenix keeps each payer's current policies in our coding rules: bundling, modifier use, frequency limits and code pairs a payer won't pay together. Coders apply the payer's policy at the point of coding, so a claim doesn't wait for a denial to find out.
Documentation that holds up in an audit
The Texas Health and Human Services Office of Inspector General compares Medicaid providers against peers in the same specialty and region. Outliers get asked for records, and a physician reviewer checks whether each code is supported. The most common finding is a code the chart doesn't support, which can lead to recoupment. Qualigenix codes only what the documentation shows. For E/M visits, coders confirm the note records time or the level of medical decision-making, and they flag cloned notes back to the provider before billing.
RESULTS ACROSS 275+ PRACTICES
Results Texas practices can expect
The figures below are Qualigenix company-wide coding and audit results across every client and state. They aren't Texas-only numbers.
98.9%
Coding accuracy
Reduced to 2%
Over/undercoding rate
100,000+ per month
Charts coded
98.6%
Audit pass rate
99%
Documentation compliance rate
300,000+ per quarter
Charts audited
Reduced to under 1%
Compliance risk
PROVEN TRACK RECORDHIPAA-Compliant Revenue Cycle
275+ ClinicsGETTING STARTED
How onboarding works
Qualigenix takes a Texas practice live on coding in 6 days on average. Here's the process.
01
Discovery call
We review your specialty, payer mix, chart volume and the denials you see most, so coders are matched to your work. We also ask about any payer or state record requests you've had.
02
EHR access
You grant coders access to your EHR. They code inside the system your providers already use, with access limited to the team on your account.
03
Payer rules setup
We load the rules your payers apply: the current Texas Health Steps guide, Novitas coverage policies for your services, and your commercial payers' coding policies.
04
Baseline review
Coders review a sample of recent charts to set an accuracy baseline and spot documentation gaps before go-live. You get the findings in writing.
05
Go-live and reporting
New encounters are coded by your assigned team, and you get a monthly report on accuracy, payer edits and documentation feedback.
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WHY PRACTICES CHOOSE QUALIGENIX
Why Texas practices choose Qualigenix
Texas practices choose Qualigenix for four reasons.
Coders assigned to your specialty
Your charts go to the same coders, who work in your specialty every day. They learn your providers' documentation habits and your payers' edits, and they hold coding accuracy at 98.9%.
Works inside your EHR
Qualigenix codes inside 133 EMR and EHR platforms. Nothing gets exported or re-keyed, and your providers keep charting the way they already do. Coding questions go to providers through the EHR they already check.
Coding feedback for providers
When a note doesn't support the code a provider expected, coders tell them why. Monthly feedback by provider shows patterns, like a missing time statement on E/M visits. Providers fix the habit once instead of losing revenue on every visit.
6-day average onboarding
Most practices go live on coding in 6 days. Coders start with a baseline review of your recent charts, so problems surface in week one. You don't wait months to learn where coding was costing you.
HAVE QUESTIONS?
Medical Coding in Texas, answered
Frequently asked questions about our setup and support in Texas.
Qualigenix is a medical coding company that serves independent practices across Texas, including Austin, Houston, Dallas and San Antonio. When you compare coding companies, ask for their coding accuracy, audit pass rate and how they handle Texas Medicaid's Texas Health Steps coding. Qualigenix reports 98.9% coding accuracy across all clients.
Yes. Qualigenix codes Texas Medicaid claims, including Texas Health Steps checkups with the required provider-type modifiers and condition indicators. Coders follow the current Texas Health Steps guide and the coding rules each Medicaid health plan applies. When the state revises the guide, coding rules are updated for your practice.
Qualigenix coders check each Medicare claim against the Novitas local coverage determinations and billing and coding articles for that service. If the diagnosis code doesn't support medical necessity under the policy, the chart goes back to the provider before the claim is sent.
Yes. Qualigenix coders are certified and assigned by specialty, so your charts are coded by people who know your specialty's codes and payer rules. The same coders stay on your account, so they learn your providers' documentation. Talk to a coding specialist about the team that would work on your account.
Yes. Qualigenix audits a sample of your charts against payer rules and documentation standards, then reports findings by provider. You see which codes are at risk before a payer or the state asks for records. Across clients, Qualigenix audits 300,000+ charts per quarter at a 98.6% audit pass rate.
Qualigenix charges a percentage of collections, so the fee is tied to what your practice is paid. The rate depends on your specialty, chart volume and services. A coding specialist can quote your rate after reviewing your chart volume.
Qualigenix keeps a 1-day charge lag, so most encounters are coded and entered the day after the visit. Fast coding matters in Texas, where Medicaid's 95-day filing window starts on the date of service.
Yes. Every Qualigenix client signs a business associate agreement, and Qualigenix follows HIPAA rules for every chart. Coders access charts only inside your EHR, and only the team assigned to your account can see them.