Texas has the highest uninsured rate in the US (18%+) and a Medicaid program that has not expanded under the ACA. STAR, STAR+PLUS, CHIP, and STAR Kids are the major managed care programs, each with distinct billing rules. Timely filing is 95 days for Medicaid claims and 12 months for most commercial payers — one of the sharper Medicaid deadlines in the country.
Texas runs one of the largest Medicaid managed care programs in the country, with most beneficiaries enrolled through STAR, STAR+PLUS, STAR Kids, or CHIP plans rather than fee-for-service. Claims route through TMHP (Texas Medicaid & Healthcare Partnership), and the state's 95-day timely filing window is among the shortest for any Medicaid program. On the commercial side, Blue Cross Blue Shield of Texas (an HCSC plan) is the dominant payer statewide, with heavy Medicare Advantage penetration in the major metros.
Administered by the Texas Health and Human Services Commission (HHSC), claims processed through TMHP. The patient's plan assignment — not just Medicaid eligibility — determines the portal, prior-auth list, and filing rules that apply.
| Plan | Notes |
|---|---|
| Superior HealthPlan (Centene) | Largest STAR/STAR+PLUS footprint; also operates Ambetter marketplace plans |
| Amerigroup Texas (Elevance) | Major STAR and STAR+PLUS presence in urban service areas |
| Molina Healthcare of Texas | STAR, STAR+PLUS, and Marketplace; distinct portal and PA rules |
| Community Health Choice | Houston-area nonprofit plan; STAR and CHIP |
| Texas Children’s Health Plan | Pediatric-focused STAR and CHIP plan in Houston region |
| Parkland Community Health Plan | Dallas-area STAR and CHIP plan |
Initial-claim windows for the payers Texas practices bill most. Commercial limits are contract-specific — always confirm against your provider agreement and the payer's current manual.
Verified against payer publications at time of writing (July 2026). Filing limits change by contract and plan year — treat this table as a starting point, not a substitute for the payer manual. See our methodology.
STAR, STAR+PLUS, STAR Kids, and STAR Health each have distinct enrollment, authorization, and billing rules. A patient’s program assignment determines which MCO portal and PA list applies.
The Texas Medicaid Provider Procedures Manual (TMPPM) is updated monthly. Fee schedules, benefit limitations, and modifier rules change often enough that stale references cause denials.
The short Medicaid filing window means eligibility or claim errors discovered late are often unrecoverable. Front-end verification matters more in Texas than in most states.
Texas metros are among the fastest-growing Medicare Advantage markets — payer mix in a typical practice is shifting toward MA plans with prior-auth-heavy workflows.
Benchmark your denial rate, Days in AR, and clean claim rate against 2026 specialty data.
Frequently billed codes in this state’s payer environment, with notes on state-specific rules and common denial patterns.
Codes and reimbursement rates change annually. Verify current fee schedules with each payer before billing. Full code lookup →