Medical Billing Company in Texas | Built for a 13+ MCO Medicaid System

Texas Medicaid runs through four distinct managed care programs: STAR (children, pregnant women, and some adults), STAR+PLUS (seniors and adults with disabilities), STAR Kids (children with disabilities), and STAR Health (foster care), plus separate CHIP coverage. More than 13 Managed Care Organizations operate across these programs, including UnitedHealthcare Community Plan, Molina Healthcare of Texas, Superior HealthPlan, Wellpoint (formerly Amerigroup), BlueCross BlueShield of Texas Medicaid, Aetna Better Health of Texas, and Cigna-HealthSpring, among others. Not every MCO serves every region. Coverage depends on the service delivery area, so a Houston practice and a Lubbock practice may work with entirely different payer sets even under the same STAR program. All Texas Medicaid MCOs use CAQH ProView as their shared credentialing data infrastructure, which is one point of consistency across an otherwise fragmented system. Texas has not expanded Medicaid under the ACA and remains a non-expansion state. Coverage is limited mainly to children, pregnant women, seniors, and people with disabilities, which shapes the payer mix billing teams see day to day toward pediatrics, OB-GYN, and long-term care specialties. Provider enrollment through TMHP's PEMS system currently takes 90 to 150-plus days given the state's federally mandated processing requirements, so credentialing timelines need to be planned well ahead of a new provider's start date. Mediknocx's team tracks MCO-specific billing rules across STAR, STAR+PLUS, and STAR Kids alongside commercial payer requirements from BlueCross BlueShield of Texas and other major carriers active in the state.