Medical Billing Services in Texas
Medical billing support for Texas practices, medical groups, and facilities that want fewer preventable denials, firmer A/R follow-up, and reporting they can read.
QWay Healthcare handles eligibility, coding, claims, payment posting, denial management, and A/R for independent practices, physician groups, hospitals, ambulatory facilities, community health centers, behavioral health organizations, and specialty providers across Texas. QWay supports more than 6,000 providers.
Request a call backOne Team for Your Entire Revenue Cycle
Revenue leaks at both ends of a claim. A Medicaid patient enrolled in a managed-care plan gets billed to the state claims administrator, and the denial arrives deep into a 95-day filing window. A workers' compensation bill goes to the wrong carrier. A missing modifier causes an underpayment that nobody reviews.
When eligibility, coding, billing, posting, and collections sit with different teams or vendors, each one passes the problem along instead of fixing it where it began. We run the cycle as one workflow:
- Front end: Eligibility and benefits verification, registration checks, responsible-payer identification, and prior authorization support before the visit.
- Coding: ICD-10-CM, CPT, HCPCS, and modifier assignment by [certified] coders, with provider queries when documentation falls short.
- Claims: Charge entry, payer-specific claim edits, electronic submission, and rejection follow-up.
- Payments: Payment posting, reconciliation, remittance review, and underpayment review.
- Denials and A/R: Root-cause analysis, corrected claims, appeals, aging follow-up, and old-balance cleanup.
- Patient billing: Statements and balance follow-up.
- Credentialing: Enrollment, recredentialing, and revalidation for Texas Medicaid, Medicare, commercial, and managed-care payers.
- Reporting and connectivity: Performance reports and support for EHR, practice management, clearinghouse, and EDI workflows.
Where Texas Providers Lose Revenue
Texas Medicaid and CHIP Use More Than One Billing Path
Claims go either to the Texas Medicaid & Healthcare Partnership (TMHP) or to a managed-care plan under STAR, STAR+PLUS, STAR Kids, STAR Health, or CHIP. The state filing deadline is 95 days from the date of service, and each plan sets its own appeal windows. A claim sent down the wrong path can age past the deadline before anyone reads the denial.
The billing team confirms the member's program and plan at scheduling, submits to the responsible payer, and follows unresolved claims through that plan's appeals.
Workers' Compensation Runs on Texas DWC Rules
Bills go to the insurance carrier within 95 days of the date of service and must be submitted electronically. Certified networks can set their own documentation requirements, while non-network claims follow state rules. A bill that is incomplete, corrected after the window closes, or sent to the wrong carrier can lose its right to payment.
The team bills under the correct pathway, tracks pre-authorizations and network referrals, and follows disputed bills with the carrier and the Division of Workers' Compensation.
Some Texas Employers Opt Out of Workers' Compensation
Texas is the only state that lets private employers decline coverage. When an injured worker's employer is a non-subscriber, no carrier exists to bill, and the claim follows a different path, such as an employer injury benefit plan or the patient's health coverage.
Our front-end team checks the employer's coverage status before the first claim goes out, so the bill reaches the party responsible for it.
Commercial Plans Update Requirements Independently
Blue Cross and Blue Shield of Texas, UnitedHealthcare, Aetna, Cigna, Humana, Baylor Scott & White Health Plan, and regional plans each change authorization, coding, modifier, filing, and appeal rules on their own schedule. Many Texas employers also self-fund, so the administrator's policies apply in place of state insurance rules. A process that worked last benefit year, or with one plan, can fail with the next.
We keep payer-specific claim edits, sort unresolved claims by aging bucket, review payment variances, and adjust workflows whenever a plan changes its requirements.
Medicare and Medicare Advantage Need Different Handling
Original Medicare claims from Texas providers go to Novitas Solutions, the Medicare Administrative Contractor for Jurisdiction H. Medicare Advantage plans set their own referral, authorization, claim-submission, and appeal requirements.
We confirm the coverage type at scheduling, so each claim reaches the right payer the first time.
What We Measure and Report
We track denial rate, A/R over 90 days, collection turnaround time, coding accuracy, payment variances, and recurring payer issues against targets agreed at setup.
Reports break out results by payer, provider, location, specialty, denial category, and aging bucket. A group can see which sites generate the most rework, which payer workflows keep producing the same denial, and which payers pay slowly.
Each denial is categorized by cause: documentation, coding, eligibility, authorization, or payer policy. Documentation gaps go back to the provider with a specific request, and coding errors are corrected in the billing workflow.
Providers We Support Across Texas
QWay supports practices and facilities across Texas, including Houston, Dallas, San Antonio, Austin, Fort Worth, El Paso, Arlington, Corpus Christi, Plano, Lubbock, Irving, and communities throughout the state.
- Independent practices and medical groups: Less claim rework, steadier coding, clearer denial patterns, and structured A/R follow-up.
- Orthopedic, pain management, physical therapy, and chiropractic practices: Workers' compensation workflows, authorization tracking, injury documentation, and aging management.
- Hospitals and health systems: Prioritized follow-up on high-value accounts, underpayments, payer delays, and complex A/R.
- Behavioral health providers: Authorized visit limits, time-based coding, payer requirements, and recurring denial trends.
- Urgent care centers and ambulatory surgery centers: Eligibility, responsible-payer, and authorization checks before service, then timely follow-up on rejected claims.
- Community health centers and FQHCs: Medicaid and CHIP workflows, sliding-fee handling, patient balances, and payer enrollment.
- Primary care, pediatric, and specialty practices: Medicaid, Medicare, managed-care, commercial, and patient-balance workflows.
How Your Revenue Cycle Review Begins
Review. We study your denials, A/R aging, and payer mix to find where reimbursement slows down.
Setup. We agree on scope, targets, and system access.
Daily management. QWay runs the agreed scope, from eligibility and coding through claims, posting, denials, and A/R.
Reporting. You receive scheduled reports, and we adjust processes when the numbers show a gap.
Find the Gaps in Your Revenue Cycle
Share your specialty, payer mix, denial trends, and A/R aging with QWay Healthcare. We’ll review your billing workflow and identify opportunities to reduce denials, improve follow-up, and accelerate reimbursement.