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Revenue cycle management services
in Houston, TX
Qualigenix runs the full revenue cycle for Houston practices, from the eligibility check before a visit to the last dollar posted. HIPAA compliant.
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How Qualigenix serves Houston practices
Qualigenix manages every step between a scheduled visit and a paid claim for Houston practices, for all payers. Most revenue in a Houston practice is lost before the claim is filed: a patient's Medicaid plan changed, an authorization lapsed or a balance was never collected. Statewide rules, like Texas prompt-pay timelines and the Medicaid filing window, are covered on our page for revenue cycle management services in Texas. This page covers the Houston payer mix. Harris County patients move between Medicaid managed care plans, Original Medicare, Integrated D-SNPs and commercial carriers. Qualigenix checks coverage before the visit, tracks authorizations through the claim and works every unpaid dollar by payer. One team owns the whole cycle, so nothing falls between a front desk and a billing vendor.
What revenue cycle management services does Qualigenix provide in Houston?
Qualigenix revenue cycle management services cover eligibility and benefits checks, prior authorization, coding, claim submission, payment posting, denial appeals, A/R follow-up, patient billing and monthly reporting.
One team handles every payer a Houston practice sees, including the Harris service area Medicaid plans. Pricing is a percentage of collections.
Revenue cycle management for Harris County's Texas Medicaid plans
Qualigenix runs the revenue cycle for the Medicaid managed care plans in the Harris service area. The Texas Health and Human Services Commission's January 2026 table lists five STAR and CHIP plans there, three STAR+PLUS plans and three STAR Kids plans. Each one has its own eligibility file, authorization rules and payment schedule.
Eligibility checked against five Harris plans before the visit
Qualigenix verifies each Medicaid patient's plan before the appointment, not after the denial. Houston's STAR and CHIP patients can be in Community Health Choice, Molina, Texas Children's, United or Wellpoint, and members can change plans. Our team runs eligibility and benefits verification ahead of each visit, records the plan in effect on the date of service and flags any patient whose coverage has lapsed. That one step decides where the claim goes, which authorization rules apply and what the patient owes. Practices that skip it lose claims to the wrong payer, and those claims can age past the filing window while they bounce between plans.
Authorizations tracked from request to payment for STAR+PLUS and STAR Kids
Qualigenix handles prior authorization for STAR+PLUS members, served in the Harris service area by Community Health Choice, Molina and United, and STAR Kids members, served by Texas Children's, United and Wellpoint. Texas rules give Medicaid plans three business days to tell the provider when a request is missing information, and three business days to decide once it arrives. Our prior authorization team sends complete requests the first time, answers plan questions inside that window and ties each approval number, unit count and date range to the claim it covers.
Texas revenue cycle rules that apply statewide
Texas Medicaid expects most claims within 95 days of the date of service, and commercial carriers must pay clean electronic claims within 30 days. Qualigenix tracks both clocks on every claim. A Medicaid claim nearing day 95 moves to the front of the queue, and a commercial clean claim unpaid past its deadline goes to follow-up the same week. For the full set of statewide rules, see how Qualigenix runs the revenue cycle across Texas.
RESULTS ACROSS 275+ PRACTICES
Results Houston practices can expect
Qualigenix's numbers below are company-wide results across 275+ practices in 48 states, not Houston-only figures.
98.2% on first submission
First-pass clean claim rate
4.8%
Denial rate
97.7%
Net collections 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 Houston practice's revenue cycle in 6 days on average.
01
Revenue review
We look at your payer mix, denial reasons, A/R aging and front-desk workflow.
02
System access
Our team works inside your EHR and practice management system, one of 133 platforms we support.
03
Front-end setup
We build eligibility and authorization checks for each Harris County Medicaid plan, Novitas and your commercial payers.
04
Cycle goes live
New visits run through our process, and old A/R is worked oldest and largest first.
05
Monthly reporting
You get collections, denials, A/R aging and patient balances by payer each month.
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WHY PRACTICES CHOOSE QUALIGENIX
Why Houston practices choose Qualigenix
Texas practices hand Qualigenix their revenue cycle for four reasons.
One team from eligibility to payment
The team that checks coverage is the team that works the denial. When a Harris plan denies for eligibility or authorization, the fix goes back to the front-end check, so the same denial doesn't repeat next month.
Works with any EHR
Qualigenix works inside the system you already use, across 133 EMR/EHR platforms. Your front desk keeps its workflow, and our team handles the checks behind it.
Monthly reporting by payer
You see collections, denials and A/R for each payer, including each Harris County Medicaid plan, so you can tell which plan is slow to pay and which denials keep coming back.
6-day average onboarding
Most practices go live in about a week, and open A/R is worked from day one, starting with the claims closest to their filing deadline.
HAVE QUESTIONS?
Frequently Asked Questions
Frequently asked questions about our setup and support in Houston.
Qualigenix is a revenue cycle management company that serves Houston practices across 38+ specialties and works all payers, including the Medicaid plans in the Harris service area. Compare RCM companies on net collections rate, days in A/R and reporting. Talk to a revenue cycle specialist to see ours.
Qualigenix covers eligibility checks, prior authorization, coding, charge entry, claim submission, payment posting, denial appeals, A/R follow-up, patient billing and monthly reporting. You can hand us the full cycle or the parts your team can't cover. Request a consultation to scope it.
Yes. Qualigenix submits and tracks prior authorizations for the STAR, STAR+PLUS and STAR Kids plans in the Harris service area, and ties each approval to the claim it covers. Missing or expired approvals are caught before the visit, not after the denial. Talk to a revenue cycle specialist about your authorization volume.
Qualigenix bills Original Medicare through Novitas Solutions. For dual-eligible patients in Harris County, we confirm which Integrated D-SNP and paired STAR+PLUS plan they hold before the visit, so the claim, authorization and cost-sharing all go to one company. Ask a revenue cycle specialist about your dual-eligible patients.
Qualigenix works unpaid claims by age and payer, appeals denials with a 79% overturn rate and stops bad claims at the front end. Across our clients, days in A/R dropped from 54 to 36. Ask a revenue cycle specialist to review your aging report.
Qualigenix charges a percentage of collections, so our fee rises only when your collections do. The exact percentage depends on your specialty, volume and the services you need. Request a consultation to get a quote for your practice.
No. What matters is that your RCM team knows Harris County's Medicaid plans, Novitas's Medicare rules and Texas prompt-pay deadlines. Qualigenix builds those rules into every step and reports results monthly. Talk to a revenue cycle specialist to see how it works.