Texas Medicaid — Texas Medicaid & CHIP
| Program name | Texas Medicaid & CHIP |
|---|---|
| Provider portal | https://www.tmhp.com |
| FFS claims payer ID | No single canonical ID — routing is fiscal-intermediary-specific. Verify per clearinghouse. |
| Medicaid timely filing | 95 days from date of service |
The federal ceiling for Medicaid timely filing is 12 months under 42 CFR §447.45; most states set a shorter window. Always verify the current policy on the Texas Medicaid provider portal before filing a late-billing appeal.
BCBS licensee in Texas
The Blue Cross Blue Shield Association licensee in Texas is Blue Cross and Blue Shield of Texas (HCSC). This licensee is not yet in the QuickIntell payer registry. See the full payer directory or the BCBSA national site for a provider-portal link.
Top commercial payers in Texas
The dominant commercial insurers operating in Texas, in approximate order of lives covered. Click through for per-payer claims payer IDs, timely filing windows, prior-authorization rules, and appeal procedures.
Medicaid MCOs in Texas
Texas Medicaid & CHIP contracts with the following managed-care organizations to administer Medicaid benefits in Texas. MCO contracts dictate claims routing, prior-auth workflows, and appeal deadlines — route each claim by the member's MCO assignment, not the state FFS payer ID.
State-specific regulations affecting Texas billing
- SB-1264 (TX Balance Billing Act — IDR for out-of-network at in-network facilities)
- TX Insurance Code Chapter 843 (HMO Act — prompt pay and claim dispute)
- TX HB-4 (2017, telemedicine parity and reimbursement)
Provider licensing & enrollment in Texas
Providers enroll with Texas Medicaid via TMHP PEMS (Provider Enrollment and Management System). TX also requires separate enrollment with each Medicaid MCO.
Major health systems headquartered in Texas
| Health system | Headquarters |
|---|---|
| Baylor Scott & White Health | Dallas, TX |
| Texas Health Resources | Arlington, TX |
| Memorial Hermann Health System | Houston, TX |
| Houston Methodist | Houston, TX |
| UT Southwestern Medical Center | Dallas, TX |
Frequently asked questions — Texas billing
What is the Texas Medicaid program called?
Texas's Medicaid program is known as Texas Medicaid & CHIP. Providers enroll and manage claims through the provider portal at https://www.tmhp.com.
What is the Texas Medicaid timely filing limit?
Texas Medicaid & CHIP requires initial claims to be filed within 95 days from the date of service. The federal ceiling is 12 months under 42 CFR §447.45; Texas's 95-day window is set by the state provider manual. Late-billing exceptions may be allowed with good-cause documentation — verify on the state portal before filing an appeal.
Does Texas Medicaid publish a single claims payer ID?
No single canonical claims payer ID is published for Texas Medicaid & CHIP. Claims route through the state's fiscal intermediary; look up the correct submitter ID in your clearinghouse directory (Availity, Change Healthcare/Optum, Waystar) and route managed-care claims by the member's MCO assignment.
Who are the largest commercial insurers in Texas?
The dominant commercial payers in Texas include UnitedHealthcare, Aetna, Cigna, Humana, along with the BCBS licensee Blue Cross and Blue Shield of Texas (HCSC). Each payer's claims routing, timely filing, and prior-auth rules differ — see the per-payer guides linked above.
What Medicaid managed-care organizations operate in Texas?
Texas Medicaid & CHIP contracts with 5 Medicaid MCOs tracked in the QuickIntell registry, including Centene, Anthem (Elevance Health), Molina Healthcare, UnitedHealthcare, Aetna. MCO contracts determine claims routing and appeal deadlines — route each claim by the member's MCO assignment, not by the FFS payer ID.
What state-specific billing regulations apply in Texas?
Texas has 3 tracked state-level statutes that affect medical billing and RCM: SB-1264 (TX Balance Billing Act — IDR for out-of-network at in-network facilities); TX Insurance Code Chapter 843 (HMO Act — prompt pay and claim dispute); TX HB-4 (2017, telemedicine parity and reimbursement). These sit on top of federal protections such as the No Surprises Act, HIPAA, and 42 CFR §447.45.
Run cleaner claims in Texas with QuickIntell
QuickRCM, QuickAuth, and QuickERA are tuned to Texas Medicaid & CHIP and the commercial payers on this page — eligibility, prior auth, claim scrubbing, and ERA posting all run on real payer rules, not generic adapters.
Disclaimer
This page is operational reference for medical-billing professionals. It is not legal, clinical, or contractual advice. State Medicaid policies, MCO contracts, and payer rules change without notice — always verify against the current provider manual from Texas Medicaid and the member ID card before submission.