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Revenue cycle management service
in Texas
Qualigenix runs the whole revenue cycle for Texas practices, from checking eligibility before the visit to posting the last patient payment.
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How Qualigenix serves Texas practices
Qualigenix runs revenue cycles for independent practices in Austin, Houston, Dallas and San Antonio, and for practices in the rest of Texas. We work with all payers. The difference with full RCM is that one team owns the result. When a claim is denied for eligibility, the same people who checked eligibility fix it, and they change the front-end step that missed it. Texas puts rules on almost every stage of the cycle. State-regulated health plans have set deadlines for preauthorization decisions. Texas Medicaid and commercial plans both expect claims within 95 days. Commercial plans owe penalties when they pay clean claims late. Patients on state-regulated plans are protected from certain balance bills. Qualigenix builds each of those rules into your workflow, from the scheduling desk to the patient statement. We work inside your EHR and practice management system. Your front desk keeps its tools, your providers keep charting, and you get one monthly report showing cash, A/R and denials by payer.
What revenue cycle management services does Qualigenix provide in Texas?
Qualigenix handles every step of the revenue cycle for Texas practices: eligibility and benefits checks, prior authorization, coding and charge entry, claim submission, payment posting, denial appeals, A/R follow-up, patient billing and monthly reporting.
One team works Texas Medicaid, Medicare and commercial payers, so no step waits on a handoff between vendors.
Texas revenue cycle problems we solve
Most lost revenue in Texas traces back to four stages: what happens before the visit, how fast claims go out, whether payers pay on time, and how patient balances are billed. Qualigenix runs a check at each stage.
Eligibility and prior authorization checked before the visit
Texas Medicaid patients carry a Your Texas Benefits Medicaid card, but the card alone doesn't confirm current coverage. Qualigenix verifies each Medicaid patient through TexMedConnect, the state's online portal, and checks which Medicaid health plan the patient is assigned to. For commercial patients, we confirm benefits and authorization needs. State-regulated plans in Texas generally have three calendar days to decide a non-urgent preauthorization request. Texas also exempts physicians from preauthorization for a service when at least 90% of their requests for it were approved. Qualigenix tracks those exemptions so your team doesn't file requests it no longer needs.
Claims filed inside every payer's window
Texas Medicaid and state-regulated commercial plans both set a 95-day filing limit, and Medicare claims for Texas go to Novitas Solutions. A charge that sits in the system for a week burns part of that window. Qualigenix keeps a 1-day charge lag and submits claims within 24 hours on average, so most of each payer's window is still left if a claim needs correcting. Every claim carries its payer's deadline in our work queue.
Payments posted and tracked against Texas's prompt-pay timelines
State-regulated Texas health plans must pay or deny a clean electronic claim within 30 days, or 45 days on paper. When an HMO pays late, Texas law adds a penalty based on the gap between billed charges and the contracted rate. The penalty grows after 45 days past due, and after 90 days the plan also owes 18% annual interest. Qualigenix posts every payment against your contracted rate, flags claims past their payment date, and checks that any penalty owed shows up on the remittance.
Patient balances billed correctly
Patients on state-regulated Texas plans can't be balance billed for emergency care, or for care at an in-network facility when they didn't pick the provider. Qualigenix posts primary and secondary payments before a patient statement goes out, so patients aren't billed for amounts a plan still owes. When a payment dispute qualifies, the practice can take it to state arbitration instead of billing the patient. Statements are clear, itemized and sent on a set schedule, and we answer patient billing calls.
RESULTS ACROSS 275+ PRACTICES
Results Texas practices can expect
The table shows Qualigenix company-wide revenue cycle results across all clients and states. These are not Texas-only results.
98.2%
First-pass clean claim rate
4.8%
Denial rate
Reduced from 54 to 36
Days in A/R
Reduced to 38%
A/R over 90 days
79%
Denials overturned
29-32%
Cash-flow improvement
$923M+
Revenue recovered
PROVEN TRACK RECORDHIPAA-Compliant Revenue Cycle
275+ ClinicsGETTING STARTED
How onboarding works
Qualigenix takes over a Texas practice's revenue cycle in 6 days on average. The steps run in this order.
01
Revenue review
We look at your payer mix, A/R aging, denial reasons and front-desk process to find where cash is stuck today.
02
System access
You grant access to your EHR, practice management system and clearinghouse. Our team works in your systems, not a separate one.
03
Front-end setup
We set up eligibility checks through TexMedConnect and payer portals, authorization tracking by plan, and each provider's gold card exemptions.
04
Back-end setup
Contracted rates, filing deadlines and Texas prompt-pay dates are loaded so posting and follow-up run against them from day one.
05
Go-live
New visits run through the Qualigenix cycle, open A/R is worked down, and your first monthly report arrives at month end.
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WHY PRACTICES CHOOSE QUALIGENIX
Why Texas practices choose Qualigenix
Texas practices hand Qualigenix their revenue cycle for four reasons.
One team from eligibility to payment
The team that checks eligibility also posts the payment and works the denial. When something breaks, nobody blames another vendor, and the fix goes back to the step that caused it. You get one contact for every revenue question.
Works with any EHR
Qualigenix runs revenue cycles on 133 EMR and EHR platforms. You keep your practice management system, your front desk keeps its screens, and nothing needs to be migrated.
Monthly reporting by payer
Each month you see collections, A/R aging and denials broken out by payer. You'll know which Texas Medicaid plan or commercial payer is slowing your cash, and what we're doing about it.
6-day average onboarding
Most practices switch to Qualigenix in 6 days. Open A/R from your prior vendor or in-house team gets worked during the transition, so cash doesn't stall. Your front desk gets a short walkthrough of the new eligibility and authorization steps.
HAVE QUESTIONS?
RCM in Texas, answered
Frequently asked questions about our setup and support in Texas.
Qualigenix is a revenue cycle management company that serves independent practices across Texas, including Austin, Houston, Dallas and San Antonio. When you compare RCM companies, ask for their net collections rate, days in A/R and whether one team handles the full cycle. Qualigenix reports a 97.7% net collections rate across all clients.
Qualigenix RCM covers eligibility checks, prior authorization, coding, charge entry, claim submission, payment posting, denial appeals, A/R follow-up, patient billing and monthly reporting. One team runs every step for Texas Medicaid, Medicare and commercial payers.
Yes. Qualigenix files and tracks prior authorization requests with Texas Medicaid health plans, Medicare Advantage plans and commercial payers. We also track which services each provider is exempt from under Texas gold card rules, so no unneeded requests get filed.
Qualigenix verifies Texas Medicaid coverage and plan assignment through TexMedConnect before the visit, then files within the 95-day window. Medicare claims go to Novitas Solutions after a coverage policy check. Both are tracked to payment, and any denial goes to the same team for appeal.
Qualigenix cuts A/R days by fixing claims before they go out, submitting within 24 hours, and following up the day a payment is due. Across clients, days in A/R have dropped from 54 to 36.
Qualigenix charges a percentage of collections for RCM, so we're paid when your practice is paid. The rate depends on your specialty, claim volume and the services you need. A revenue cycle specialist can quote it after a short call.
Most Texas practices switch to Qualigenix in 6 days on average. Open claims from your current vendor are worked during the switch, so cash keeps coming in. Your staff and EHR stay the same.
Yes. Qualigenix works under HIPAA rules and signs a business associate agreement before taking on any revenue cycle. Patient data stays inside your EHR, practice management system and clearinghouse.