Medical billing services for Houston practices
SFA Solutions handles billing for Houston practices from our office in Austin, working inside the EHR and practice management system you already use. Our U.S.-based team knows the Harris service area Medicaid plans, the Medicare Advantage carriers that cover most local seniors, and the 95-day deadlines that apply to most Texas claims.
Remote service from our Austin, Texas headquarters. No EHR migration required.
Billing alongside the Texas Medical Center
The Texas Medical Center describes itself as the largest medical complex in the world, with about 10 million patient encounters a year. Many Houston physicians are employed by Memorial Hermann, Houston Methodist, Baylor St. Luke's, MD Anderson or an academic group, and independent practices often round at those hospitals. That split shows up on the claim: hospital visits bill with place of service 21, 22, 19 or 23 at the facility rate, while office visits bill with POS 11 at the higher non-facility rate. A wrong POS code is one of the most common reasons a Houston specialist's payment does not match the fee schedule.
The Harris service area for Medicaid
Houston practices fall in the Harris Medicaid managed care service area, which covers Austin, Brazoria, Fort Bend, Galveston, Harris, Matagorda, Montgomery, Waller and Wharton counties. Five plans offer STAR here, including two local plans: Community Health Choice, which is affiliated with Harris Health, and Texas Children's Health Plan. Each MCO credentials, authorizes and pays on its own rules, so a practice that sees STAR, STAR Kids and STAR+PLUS members may be working with five different plans at once.
Most Houston seniors are in Medicare Advantage
CMS enrollment data from March 2025, compiled by the RUPRI Center for Rural Health Policy Analysis, shows 66.8% of Medicare-eligible residents of Harris County enrolled in Medicare Advantage, compared with 58.9% statewide. For a Houston practice, that means most senior visits are billed to a Humana, UnitedHealthcare, Wellcare or other MA plan with its own prior authorization lists and appeal rules. Novitas Solutions, the Jurisdiction H Medicare contractor, only processes the traditional Medicare share, so we check coverage at each visit before the claim is built.
Workers' comp claims in an industrial city
Houston's energy, petrochemical, port and construction employers generate a steady flow of work injury visits. Texas lets most private employers choose whether to carry workers' compensation, so the first step is confirming coverage through the Texas Department of Insurance. For covered claims, Division of Workers' Compensation rules require the bill within 95 days of the date of service (28 Tex. Admin. Code Section 133.20), and the carrier must pay, reduce or deny a complete bill within 45 days. Injuries at employers without coverage are billed to the employer's own injury plan or the patient's health plan instead.
Harris service area
HHSC announced new STAR and CHIP contract awards in 2024, but a Travis County court blocked them in October 2024 and the state appealed. HHSC's service area map revised in January 2026 still shows the plans listed here, so treat this list as current for now and confirm the member's plan in TMHP or the plan portal before each visit.
- Community Health Choice (STAR, STAR+PLUS, CHIP)
- Molina Healthcare (STAR, STAR+PLUS, CHIP)
- Texas Children's Health Plan (STAR, STAR Kids, CHIP)
- UnitedHealthcare Community Plan (STAR, STAR+PLUS, STAR Kids, CHIP)
- Wellpoint (STAR, STAR Kids, CHIP)
- Superior HealthPlan (STAR Health, statewide)
Major health systems in the area
- Houston Methodist
- Memorial Hermann Health System
- Harris Health
- Baylor St. Luke's Medical Center (St. Luke's Health)
- Texas Children's Hospital
- The University of Texas MD Anderson Cancer Center
- HCA Houston Healthcare
- UTHealth Houston
Specialty mix
Houston has a deep specialist base built around the Texas Medical Center, including oncology, cardiology, orthopedics and pediatric subspecialties, plus a large primary care and multispecialty group market across the suburbs. Specialists who split time between their office and TMC hospitals need careful place of service coding and, for interpretations, modifier 26 on the professional component. Primary care and pediatric practices in Harris, Fort Bend and Montgomery counties tend to carry a heavier Medicaid and CHIP share, which makes MCO eligibility checks and the 95-day filing limit the main revenue risks.
Also serving practices in Sugar Land, Katy, The Woodlands, Pearland, Pasadena, League City, Cypress, Baytown.
Houston medical billing questions
Which Medicaid plans can my Houston practice see?
Houston is in HHSC's Harris service area. STAR is offered by Community Health Choice, Molina, Texas Children's Health Plan, UnitedHealthcare Community Plan and Wellpoint. STAR+PLUS is offered by Community Health Choice, Molina and UnitedHealthcare, and STAR Kids by Texas Children's, UnitedHealthcare and Wellpoint. You need a separate credentialing contract with each plan you want to see.
How do you bill workers' comp for Houston patients?
We first confirm the employer actually carries Texas workers' compensation, since most private employers can opt out. For covered injuries we bill the carrier under DWC rules within 95 days of service and follow up if a complete bill is not paid, reduced or denied within 45 days. Uncovered injuries are billed to the employer's plan or the patient's health insurance.
Do you have an office in Houston?
No. SFA Solutions is based at 5900 Balcones Dr in Austin and works with Houston practices remotely. We log in to your existing EHR or PM system using access you grant and can revoke, and you get a named account manager.
How do we get started?
Start with a free practice audit. We review your billing and walk you through where revenue may be slipping, with no commitment. If you move forward, service is month-to-month with 60 days' notice, and we can typically begin within 24 hours of receiving system access.
Sources
- Texas HHSC: Medicaid and CHIP managed care service areas map (MCOs as of January 2026)
- Texas HHSC STAR+PLUS Handbook, Appendix XXXVIII: service areas by county
- Texas Medical Center: About TMC
- RUPRI Center: Texas Medicare Advantage enrollment by county (CMS data, March 2025)
- 28 Tex. Admin. Code Section 133.20, Medical Bill Submission by Health Care Provider (workers' compensation)
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Find out where your practice may be losing revenue
Request a free practice revenue audit. We review your billing and walk you through where revenue may be slipping. No commitment, and no patient records are required to request an initial review.