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Texas · Skilled Nursing Facilities

Skilled Nursing Facilities Billing in Texas

Case-mix classification driven by assessment data, where the assessment itself sets the payment rate.

Remote medical billing — monthly close, cleanup, and books ready for your practice.

Consolidated billing makes the facility responsible for most services, and Medicaid is the dominant long-stay payer in most states. In Texas that plays out against a specific set of rules rather than a general one.

Claims for Texas providers are adjudicated by Novitas Solutions (JH), which is also who hears the first level of appeal — so an appeal argument that works here works in every state that contractor covers.

At a glance

Coding driver

Case-mix classification driven by assessment data, where the assessment itself sets the payment rate.

Medicare contractor

Novitas Solutions (JH)

Medicaid program

Texas Medicaid (STAR)

Auto injuries

Tort state — health plan sequencing applies

What changes in Texas

Medicaid in Texas runs as Texas Medicaid (STAR) and is delivered largely through commercial managed care plans, so most Medicaid claims are adjudicated by an insurer with its own filing window and its own authorization rules rather than by the state.

Where skilled nursing facilities claims fail

  • Assessment not completed inside the required window
  • Services billed separately under consolidated billing
  • Skilled level of care not documented daily

We work the claims. You practice medicine.

Coding, claim submission, denial management, and A/R follow-up — with nothing left for your front desk to chase.

View pricing

How It Works

1

Review

We look at your Texas skilled nursing facilities denials.

2

Scope

A written scope and price before any work starts.

3

Transition

Coding and submission move across without a gap.

4

Report

Denial causes segmented by payer and provider.

Skilled Nursing Facilities Billing in Texas — Frequently Asked Questions

Do skilled nursing facilities billing rules differ in Texas?

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Texas Medicaid (STAR) is delivered through commercial managed care plans, each setting its own filing window and authorization rules.

Ready for books you can actually trust?

Book a free consultation and we will tell you what your revenue cycle needs and what it costs.

  • Done-for-you
  • Solo or group
  • Nationwide

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(409) 880-5990
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