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  • 1-855-838-1370
  • 4 Scammon Street, Suite 19-343, Saco, ME 04072
  • Mon to Fri 9:00AM to 06:00PM EST
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Shoreline Healthcare Technologies 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 2015.

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

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Shoreline Healthcare Technologies 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

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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 Healthcare Technologies 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.

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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 Healthcare Technologies 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.

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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 Healthcare Technologies provides personalized support tailored to the unique needs of Texas providers.

Our team of experts understands the intricacies of the Texas healthcare landscape and offers guidance to help practices navigate these challenges effectively with our cloud-based RCM solutions that optimize Revenue Cycle Management.

Comprehensive Medical Billing Services for Texas

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Specialized Services tailored to meet Texas’s Medicaid rules and regulations

🩺 Services 📍 Texas Specialization 📈 Typical Improvement ⏱️ Turnaround Time
Medicaid & STAR Billing Integration with TMHP for Medicaid billing, virtual assistants for real-time eligibility verification, electronic claim scrubbing software. +35% Faster reimbursements, clean claims and reduced rejections. 1-2 weeks
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. +20% increase in revenue through cross-payer optimization. 24-48 Hours
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 Reduce rate of denial by 75% and with quicker appeals. 5-7 days
Credentialing & Enrollment Full-service credentialing with TMHP/PEMS, Medicaid and CHIP provider enrollment, revalidation support. Direct payment activation and inclusion in value-based care incentive programs. 45-90 days
Patient Statements & Follow-Up Communicate with patients and give Explanation of Benefits (EOBs) Reduces overdue balances and better collection rates. 1-2 weeks

Medical Billing Resources for Texas

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Comprehensive resources specifically designed for Texas Healthcare Providers to navigate the complex Billing Landscape.

Medicaid Billing Guide

Complete guide to Medicaid billing requirements and policy updates.

Managed Care program rules and guidelines

Specialized billing guidelines for managed care programs.

Revenue Cycle Optimization

Strategies to improve cash flow and reduce denials.

Telehealth and Remote patient Monitoring in Texas

Texas’s telehealth and RPM guidelines and regulations.

Serving Healthcare Providers Across Texas

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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.

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Primary Care
Specialty Clinic
Rural Health
Mental Health
Cardiology
Dermatology
Emergency Medicine
Family Medicine
Internal Medicine
Neurology
Oncology
Orthopedics
Pediatrics
Psychiatry
Radiology
Surgery
Urgent Care
Women's Health

Frequently Asked Questions

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FAQs about Medical Billing Services in Texas.

Q1. How can Providers check the patient’s eligibility for Texas Medicaid programs?

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Providers can check Texas Medicaid eligibility through

  • ✔ The online TMHP Portal / TexMedConnect
  • ✔ Submitting eligibility inquiries via billing software for automated responses.
  • ✔ Calling the IVRS AT 1-800-925-9126
  • ✔ Verifying through the patient’s managed care organization.

Q2. What is the timely filing limit for Medicaid claims in Texas?

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All original Medicaid claims should be submitted within 95 days from the date of service.

Q3. How can providers enroll themselves as Texas Medicaid Providers?

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Providers can enroll in the Medicaid program of Texas through the Provider Enrollment and Management System (PEMS), maintained by the TMHP. It acts as the sole platform for all enrollment, revalidation, and maintenance activities.

Q4. What is the difference between TMHP and Medicaid Managed Care Organizations (MCOs)?

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TMHP: Handles claims and services under fee-for-service Medicaid.

MCOs: Handle claims and care management under managed care programs (STAR, STAR+PLUS, STAR Kids, etc.).

Q5. How can Shoreline Healthcare Technologies help Texas providers?

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We at Shoreline Healthcare Technologies handle the entire process of RCM Cycle from patient appointment scheduling to eligibility checks, prior auths, coding, claim submissions, denials, and appeals, till payment processing and patient communication ensuring faster payments and compliance with state specific rules.

Compliance & Certifications

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Your data security and compliance are our top priorities.

HIPAA Compliant

Full HIPAA compliance with regular audits

AAPC Certified

Certified Professional Billing Staffs.

Texas Licensed

Licensed to operate in Texas

Medical Billing Glossary

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Essential Terms for Understanding Texas’s Medical Billing Landscape

Health and Human Services Commission (HHSC):

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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:

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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:

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The online portal of Texas used by providers to check eligibility, submit claims, and verify authorizations. It is managed by the TMHP.

Texas Medicaid & Healthcare Partnership (TMHP)

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TMHP is the primary administrative contractor ensuring that Medicaid program runs efficiently in Texas. They manage processes like Medicaid claims, provider enrollment, and other benefit administration on behalf of HHSC.

Texas Health Steps (THSteps):

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It is the preventive care program for children (Texas version of EPSDT)which covers screenings, vaccines, and follow-up services.

Our Top-Notch Medical Billing Features

Our Services

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Shoreline proudly supports physicians, medical groups, and medical billing companies. Following are the revenue cycle management steps we offer.

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Testimonials

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We Care

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From electronic health records, billing services and practice management tools – Shoreline has you covered! In addition to being an industry leader when it comes to pricing, we also provide personalized support for every client, with a team of experts who have worked with physicians and medical groups for years, Shoreline Healthcare Technologies in Texas understands how to navigate today’s complex healthcare revenue environment.

Ready to Optimize Your Medical Billing?

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Get your free consultation and discover how much you could save with our Texas-specialized billing services.

Get Your Free Consultation

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Contact Information

  • 4 Scammon Street, Suite 19-343, saco, ME 04072
  • 1-855-838-1370
  • info@shorelinemb.com
  • M-F, 9am - 5pm EST

Why work with us?
  • 40% average denial rate reduction
  • Texas billing specialists
  • 24-48 hour claim turnaround
  • Dedicated Texas support team