Statewide Healthcare RCM Coverage • 1,836 Cities & Towns
Medical Billing & RCM Services in Texas
Delivering tailored medical coding, billing, and credentialing services across Texas. Serving healthcare providers, clinics, and hospital groups with an exceptional 98% clean claim rate.
Statewide Regulatory & MAC Compliance Hub
Texas Medicare MAC Jurisdiction & Payer Regulations (J-H)
Comprehensive Part A/B Medicare contractor policies, LCD standards, and state Medicaid filing rules for Texas medical practices.
98.2% First-Pass Clean Claim Rate
Medicare Administrative Contractor (MAC)
J-H
Jurisdiction H (J-H)
Contractor:
Novitas Solutions, Inc. (HQ: Mechanicsburg, PA)
State Medicaid & Public Health Agency
TX
Texas Medicaid & Healthcare Partnership (TMHP)
Governing Agency:
Texas Health and Human Services Commission (HHSC)
Medicaid Timely Filing:
95 days from Medicare Remittance (RA) date
Medicare Timely Filing Window
12 months (365 days) from Date of Service
First-Level Appeals (Redetermination)
120 calendar days from Remittance Advice (Redetermination)
First-Pass Clean Claim Target
98.2% Scrubber Rate
Active Local Coverage Determinations (LCDs) in Texas (J-H):
4 Active LCDs
L35041
Wound Care & Cellular/Tissue-Based Products (CTPs)
L35049
Monitored Anesthesia Care (MAC) Sedation
L36130
Major Joint Replacement (Hip & Knee) Clinical Necessity
L35172
Botulinum Toxins for Migraines and Spasticity
Regional Billing Nuances & Compliance Safeguards:
Texas TMHP Crossover Compliance: Secondary claims crossing to TMHP require active Master Provider Index (MPI) enrollment and strict 95-day filing deadline from Medicare EOB date.
Novitasphere EDI & MBI Discovery: Real-time Medicare Beneficiary Identifier (MBI) lookup, automated Redetermination filing via CMS-20027 e-forms.
Mandatory single-use drug vial wastage recording with JW/JZ modifiers.
Targeted Probe and Educate (TPE) audit defense protocols for high-frequency E/M coding.
Healthcare Locations & Cities in Texas
Select your city below for specialized local medical billing solutions and regional payer expertise.