Expert Medical Billing Services in Texas

Texas practices work across commercial insurance, Medicare, Texas Medicaid, Workers’ Compensation, and patient-pay balances, each with different documentation, filing, and follow-up requirements. PureMD Group provides outsourced medical billing services in Texas that connect claim preparation, submission, payment posting, denial resolution, and A/R follow-up. We define responsibilities around your specialty, payer mix, systems, and open balances so your team can see what is being worked, what is delayed, and what requires practice input.

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Our Key Performance Indicators

Collection Ratios

1 %

Revenue Increase

1 %

Billing Specialties

1 +

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PureMD Group supports billing, denial management, credentialing, and lien recovery for practices with complex accounts.

Outsourced Medical Billing That Works With Your Texas Practice

A claim rarely becomes unpaid for only one reason. Incorrect coverage data can lead to a rejection, missing authorization can lead to a denial, incomplete documentation can delay coding, and an unresolved payer request can leave an account aging without a clear next action. PureMD Group’s medical billing services in Texas connect physician billing with coding support, payment posting, denial management, and accounts receivable follow-up. The service scope is built around the work your staff retains, the tasks PureMD manages, the systems both teams use, and the reports practice leaders need to monitor claims, payments, and outstanding balances. Texas adds another layer because the process varies by plan and claim type. TDI-regulated commercial claims, Texas Medicaid, Workers’ Compensation medical bills, and Personal Injury accounts do not share one filing or dispute path. PureMD organizes each account around the applicable payer, deadline, documentation, and escalation route instead of treating every unpaid balance the same way.

Texas Billing Rules That Affect Claim Follow-Up

The correct deadline and resolution path depend on who administers the benefit, which program covers the service, and whether the account involves commercial insurance, Medicaid, Workers’ Compensation, or patient responsibility.

Commercial Clean Claim Timelines

Texas prompt-pay rules generally require qualifying TDI-regulated carriers to act on an electronic clean claim within 30 days and a nonelectronic clean claim within 45 days. The rule does not cover every plan. Many self-funded employer plans, Medicare, Medicaid, and Workers’ Compensation follow different frameworks, so plan identification comes before deadline tracking.

Texas Medicaid Filing and Appeals

Texas Medicaid and Healthcare Partnership generally requires most fee-for-service claims from in-state providers within 95 days of the date of service and most appeals within 120 days of the disposition date on the Remittance and Status Report. Managed care organization procedures and documented exceptions can differ. Verify eligibility, enrollment, authorization, billing entity, and the current program rule for each claim.

Workers Compensation Medical Bills

Texas Workers’ Compensation uses separate medical-billing rules, electronic submission requirements with limited exemptions, approved billing formats, and applicable fee guidelines. Most medical bills must reach the carrier within 95 days of the date of service. The billing file should connect the injury, employer, carrier, claim identifiers, service codes, supporting records, acceptance response, and any reduction or denial.

Patient Balance Review

An unpaid insurance balance does not automatically belong on a patient statement. Review the explanation of benefits, contractual adjustments, coordination of benefits, network status, and applicable Texas or federal surprise-billing protections first. A “TDI” or “DOI” mark on the member ID card can help identify a state-regulated plan. Only an appropriately classified balance should move into patient follow-up.

Build the Right Billing Scope for Your Practice

A solo physician, specialty group, and multi-location practice will not need the same billing coverage. PureMD reviews provider count, specialty, payer mix, monthly claim volume, documentation handoffs, open A/R, and internal staffing before defining the engagement. Your practice can evaluate full-service medical billing solutions or focused support for the workflows creating the greatest backlog.

Discuss Your Practice’s Priorities

Full-service physician medical billing
Coding and claim-preparation support
Payment posting and reconciliation
Denial management and appeals
Payer and patient A/R follow-up
Texas Workers' Compensation and Personal Injury billing

From Patient Intake to Account Resolution

The workflow connects front-end data, documentation, claims, remittances, denials, and follow-up. Each step has an owner and a next action so rejected, denied, underpaid, and aging claims move into the correct queue.

Confirm Coverage and Billing Details

Review patient demographics, insurance information, coverage dates, plan type, coordination of benefits, referrals, and available authorization information. Flag missing or inconsistent data before the claim is built and identify whether a Texas-specific program or rule may affect the account.

Review Documentation and Charges

Match the documented service with the diagnosis, procedure, modifier, place of service, rendering provider, and charge information used for billing. Route documentation questions to the practice before submission rather than creating unsupported claim data.

Scrub Route and Submit Claims

Check payer routing, provider enrollment, required claim fields, and supporting documentation, then submit the professional or institutional claim through the agreed channel. Monitor acknowledgments so rejections can be corrected before filing limits expire and preserve proof of timely submission.

Post and Reconcile Payments

Post payer and patient payments, contractual adjustments, denial information, and patient responsibility from the remittance. Reconcile exceptions against the original charge and contract expectations so underpayments, nonpayments, and unapplied balances enter the correct follow-up queue.

Resolve Denials and Work Aging A/R

Separate rejections from adjudicated denials, identify the reason and responsible owner, and choose the appropriate corrected claim, documentation response, reconsideration, appeal, or payer follow-up. Prioritize A/R by filing risk, balance, age, payer, and likely next action.

Report Trends and Prevent Repeat Errors

Report claim status, payments, denial categories, payer behavior, and A/R aging. Use recurring patterns to improve registration, eligibility, authorization, documentation, coding, enrollment, and claim-submission workflows instead of repeatedly correcting the same downstream problem.

Serving Healthcare Providers Across Texas

Houston

Dallas

Austin

San Antonio

Fort Worth

El Paso

Arlington

Corpus Christi

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Frequently Asked Questions

Find out the answers to the questions frequently asked by our clients.

What can PureMD manage within our billing workflow?

The scope can include claim preparation and submission, payment posting, denial management, payer and patient A/R follow-up, reporting, patient statements, and related coding support. Your service agreement should identify which registration, eligibility, authorization, coding, credentialing, and patient-communication tasks remain with the practice and how exceptions move between teams.

How do Texas payer rules change claim follow-up?

The plan and program determine the filing clock, payment expectation, appeal process, and patient-billing rules. A TDI-regulated commercial claim may fall under Texas prompt-pay requirements, while a self-funded plan, Texas Medicaid claim, or Workers’ Compensation medical bill follows a different framework. The billing team must classify the account before selecting a correction, appeal, dispute, or collection path.

Can PureMD support Texas Workers Compensation and Personal Injury accounts?

Yes. Workers’ Compensation and Personal Injury billing and collections are published PureMD focus areas. Texas Workers’ Compensation support may include medical-bill preparation, injury and claim data review, documentation tracking, carrier follow-up, and response to reductions or denials. Personal Injury support may include attorney coordination, case tracking, lien documentation, and recovery follow-up based on the contracted scope.

How is pricing for outsourced medical billing determined?

Pricing depends on the agreed scope, specialty, provider count, claim volume, payer mix, open A/R, systems, reporting requirements, and whether the work includes coding, patient statements, or injury-related accounts. When comparing affordable medical billing services, ask each medical billing company serving Texas to price the same workload and explain setup fees, minimums, exclusions, and tasks that remain with your staff.