The Best Medical Billing Company in Texas - Shoreline
Shoreline Medical Billing company delivers certified billing, AR recovery, and 96% clean claim rates to healthcare providers across Texas.
Comprehensive Medical Billing Services for Texas Practices
Shoreline Medical Billing company is a proud Maine-based company that offers end to end revenue cycle management services to physicians and Medical billing companies in Texas. Our goal is to help them manage their business in a way where they can focus on patient care and operations, not paperwork! By providing great services at reduced costs, we have been able to keep our customers since our inception in 2010. Explore our case studies to see how we’ve helped practices overcome complex billing challenges and improve cash flow.
As a medical billing outsourcing company, we have helped our clients grow their business by providing them with the resources they need to succeed while maintaining a competitive edge in today’s industry. We offer timesaving, cost-effective revenue cycle management services to your Texas based practice. Ready to outsource your billing needs? We’ll guide you through your receivable account to make sure that your claims are paid.
Best In The Industry
Shoreline Medical Billing company in Texas exceed customer expectations and we are proud of our history, but more importantly we are focused on the future. We have grown in recent years by continuing to invest in technology and people while maintaining a commitment to excellent service and innovation. We have the best customer service and one of the highest success rates for reimbursement, so you know your money will be going where it belongs - back into your pocket.
Texas Healthcare Billing Challenges We Solve
Managing the shorter statewide timely-filing window
All the Medicaid claims in Texas must be received by TMHP/HHSC within 95 days of the date of service (with limited exceptions). That is much shorter than many states' windows and creates a high risk of denials for routine submission delays. We at Shoreline Medical Billing company helps providers in Texas to manage this limited timeframe by focussing on timely and accurate claims submission, aiming to minimize revenue loss for practices. Our electronic claim scrubbing software identifies and correct claim issues even before submission eliminating up to 90% of claims rejections. Our virtual assistants help to verify patient eligibility in real time and optimizing Medicaid and emergency coding to reduce denials and maximize reimbursements.
TMHP/PEMS provider-enrollment complexity and delays
Texas uses the Provider Enrollment & Management System (PEMS) through TMHP portal for enrollment and credentialing. Frequent system changes, delays (e.g., postponed PEMS credentialing launches) and complicated enrollment rules (TPI/NPI rules, revalidation) have made the process complex for providers.We at Shoreline Medical Billing company simplifies this complex Medicaid enrollment process by handling the preparation and submission of all necessary documents in compliance with the state-specific requirements, reducing the risk of delays or denials due to incomplete or incorrect information.
Varying Prior authorization rules
HHSC and TMHP require program-specific prior authorizations (and many STAR/STAR+PLUS services require MCO authorization). When HHSC centralization changes or MCOs change their PA rules, providers in Texas face frequent, program-specific PA variations and denials. We at Shoreline Medical Billing company provides personalized support tailored to the unique needs of Texas providers.
Comprehensive Revenue Cycle Management Services for Texas
Specialized Services tailored to meet Texas's Medicaid rules and regulations
Medicaid & STAR Billing
Integration with TMHP for Medicaid billing, virtual assistants for real-time eligibility verification, electronic claim scrubbing software.
Billing for Managed Care Plans
Unified billing framework for Texas Medicaid MCOs (STAR, STAR+PLUS, STAR Kids, CHIP), automated payer-specific modifier mapping and prior authorization validation.
Denial Management
AI based tools to track and flag denial codes, identify high-risk categories (e.g., long-term care, behavioral health), and automate resubmissions
Credentialing & Enrollment
Full-service credentialing with TMHP/PEMS, Medicaid and CHIP provider enrollment, revalidation support.
Patient Statements & Follow-Up
Communicate with patients and give Explanation of Benefits (EOBs)
Practice Revenue Audits
100% chart-to-claim review, NCCI edit checks, fee schedule allowable auditing, and revenue leakage detection for Texas practices.
Texas Medical Billing Knowledge Hub
Essential regulatory benchmarks, payer policies, and billing guidelines for healthcare practitioners in Texas.
Texas Medicaid Filing Windows
Claims for Texas Medicaid must be submitted within 95 days from date of service for Texas Medicaid; 90-180 days for commercial plans. Claims exceeding this window are permanently denied unless accompanied by documented proof of timely filing with another primary payer.
Statutory Pay Protection
Under Texas Insurance Code § 1301.103 / Texas Prompt Pay Act (30 calendar days for electronic; 18% annual interest), commercial insurers and HMOs must settle clean claims on time. Delayed claims trigger statutory interest penalties that our recovery team collects on your behalf.
Texas Medicaid & Healthcare Partnership (TMHP) Portal (tmhp.com) Connectivity
We maintain direct EDI connections for electronic claim submission, real-time eligibility inquiry, and rapid electronic remittance advice posting.
Serving Healthcare Providers Across Texas
From Dallam to Cameron, we provide comprehensive medical billing services statewide across all 254 counties of Texas.
Panhandle / South Plains
Armstrong, Bailey, Borden, Briscoe, Carson, Castro, Childress, Cochran, Collingsworth, Crosby, Dallam, Dawson, Deaf Smith, Dickens, Donley, Floyd, Gaines, Garza, Gray, Hale, Hall, Hansford, Hartley, Hemphill, Hockley, Hutchinson, King, Lamb, Lipscomb, Lubbock, Lynn, Moore, Motley, Ochiltree, Oldham, Parmer, Potter, Randall, Roberts, Sherman, Swisher, Terry, Wheeler, Yoakum.
Northwest Region
Archer, Baylor, Brown, Callahan, Clay, Coleman, Comanche, Cottle, Eastland, Fisher, Foard, Hardeman, Haskell, Jack, Jones, Kent, Knox, Mitchell, Montague, Nolan, Runnels, Scurry, Shackelford, Stephens, Stonewall, Taylor, Throckmorton, Wichita, Wilbarger, Young.
Metroplex Region
Collin, Cooke, Dallas, Denton, Ellis, Erath, Fannin, Grayson, Hood, Hunt, Johnson, Kaufman, Navarro, Palo Pinto, Parker, Rockwall, Somervell, Tarrant, Wise.
Northeast Region
Anderson, Bowie, Camp, Cass, Cherokee, Delta, Franklin, Gregg, Harrison, Henderson, Hopkins, Lamar, Marion, Morris, Panola, Rains, Red River, Rusk, Smith, Titus, Upshur, Van Zandt, Wood.
Southeast Region
Angelina, Hardin, Houston, Jasper, Jefferson, Nacogdoches, Newton, Orange, Polk, Sabine, San Augustine, San Jacinto, Shelby, Trinity, Tyler.
Gulf Coast Region
Austin, Brazoria, Chambers, Colorado, Fort Bend, Galveston, Harris, Liberty, Matagorda, Montgomery, Walker, Waller, Wharton.
Central Region
Bastrop, Bell, Blanco, Bosque, Brazos, Burleson, Burnet, Caldwell, Coryell, Falls, Fayette, Freestone, Grimes, Hamilton, Hays, Hill, Lampasas, Lee, Leon, Limestone, Llano, Madison, McLennan, Milam, Mills, Robertson, San Saba, Travis, Washington, Williamson.
Alamo Region
Bastrop, Bell, Blanco, Bosque, Brazos, Burleson, Burnet, Caldwell, Coryell, Falls, Fayette, Freestone, Grimes, Hamilton, Hays, Hill, Lampasas, Lee, Leon, Limestone, Llano, Madison, McLennan, Milam, Mills, Robertson, San Saba, Travis, Washington, Williamson.
West Texas Region
Andrews, Borden, Coke, Concho, Crane, Crockett, Dawson, Ector, Gaines, Glasscock, Howard, Irion, Kimble, Loving, Martin, Mason, McCulloch, Menard, Midland, Pecos, Reagan, Reeves, Schleicher, Sterling, Sutton, Terrell, Tom Green, Upton, Ward, Winkler.
Trans-Pecos Region
Brewster, Culberson, El Paso, Hudspeth, Jeff Davis, Presidio.
South Texas Region
Aransas, Bee, Brooks, Cameron, Duval, Hidalgo, Jim Hogg, Jim Wells, Kenedy, Kleberg, Live Oak, McMullen, Nueces, Refugio, San Patricio, Starr, Webb, Willacy, Zapata.
Texas Medical Billing Glossary
Key regulatory terms and definitions essential for compliant medical billing in Texas.
Health and Human Services Commission (HHSC)
It is the state agency of Texas overseeing Medicaid, CHIP, and related health programs setting policies, rates, and eligibility standards. It partners with TMHP and managed care organizations (MCOs) to deliver healthcare services across Texas.
Health and Human Services Commission (HHSC)
It is the state agency of Texas overseeing Medicaid, CHIP, and related health programs setting policies, rates, and eligibility standards. It partners with TMHP and managed care organizations (MCOs) to deliver healthcare services across Texas.
STAR / STAR + PLUS / STAR Health / STAR Kids
These are the major Medicaid managed-care programs in Texas serving different populations. Each serves different groups like adults, children, long-term care members, or those in foster care and provides specialized service coordination.
TexMedConnect
The online portal of Texas used by providers to check eligibility, submit claims, and verify authorizations. It is managed by the TMHP.
