Medical Billing & Credentialing Services | Prohealthcare Advisors
- 410 Peachtree Pkwy, Suite 4245 Cumming, GA 30041
- Email: info@prohealthcareadvisors.com
- Services
Medical Billing and Practice Management
Creative Collection Solution
MD Audit Shield – RAC
Physician Credentialing
EMR/EHR Software
Electronic Fund Transfer (EFT)
CodeMAXX Services
Hippa
Medical Billing Credentialing Texas
Built Around TMHP's PEMS Portal — Houston to Dallas
Texas Medicaid runs through the Texas Medicaid & Healthcare Partnership (TMHP), and enrollment happens in two separate steps most out-of-state vendors miss: HHSC approval through the PEMS portal first, then a separate credentialing application for every managed care organization you want to bill. We manage both, plus Novitas Solutions Medicare enrollment, for practices across Texas.
TMHP / PEMSMedicaid Enrollment System We Track Directly
Novitas — JHMedicare MAC (also covers OK, CO, NM, AR, LA)
2-StepState + MCO Credentialing Managed End-to-End
Where We Work in Texas
Houston & Dallas — Two Different Payer Landscapes
Houston Metro
Gulf Coast & Harris County Providers
Houston's payer mix skews toward large hospital-system-affiliated networks and a dense managed Medicaid population.
- Community Health Choice and Molina Healthcare of Texas MCO credentialing
- Multi-facility group NPI coordination for hospital-affiliated practices
- Harris Health System referral and coordination workflows
Dallas–Fort Worth Metro
North Texas Providers
DFW's fragmented multi-county Medicaid service areas mean MCO participation can vary by exact practice location.
- Service-area-specific MCO verification before enrollment (varies by county within DFW)
- Parkland Community Health Plan and Superior HealthPlan credentialing
- Multi-location practice AR consolidation across county lines
Texas Payer Coverage
We Bill & Credential With Texas's Full Payer Mix
| Payer | Plan Type | Texas Role | Status |
|---|---|---|---|
| Texas Medicaid (TMHP / HHSC) | State Medicaid | Enrolled via PEMS before any MCO can credential you | Full Service |
| Medicare — Novitas Solutions | Federal Medicare | MAC Jurisdiction H (TX, OK, CO, NM, AR, LA) | Full Service |
| Superior HealthPlan | Medicaid MCO | Statewide STAR/STAR+PLUS participant | Full Service |
| Molina Healthcare of Texas | Medicaid MCO | Multi-region STAR plan | Full Service |
| Community Health Choice | Medicaid MCO | Houston/Harris County region | Full Service |
| Blue Cross Blue Shield of Texas | Commercial / MA | Dominant commercial payer statewide | Full Service |
Common Questions
Medical Billing Credentialing Texas — FAQ
Why does Texas Medicaid enrollment take two separate steps?
Texas requires state-level enrollment through TMHP's PEMS portal first — this makes you a Texas Medicaid provider, but doesn't put you in any managed care plan's network. Each MCO you want to bill (Superior, Molina, Community Health Choice, etc.) requires its own separate credentialing application after PEMS approval closes.
Who is the Medicare Administrative Contractor for Texas?
Novitas Solutions administers Medicare Part A and B for Jurisdiction H, which covers Texas, Oklahoma, Colorado, New Mexico, Arkansas, and Louisiana — one of the largest MAC jurisdictions by provider count.
Does MCO availability differ between Houston and Dallas?
Yes. Texas Medicaid managed care runs through regional service areas, so which MCOs you can credential with depends on your exact practice location, not just "Texas" broadly. We verify service-area-specific plan availability before starting enrollment.
What happens if my group is enrolled but a new physician isn't?
An enrolled group NPI-2 does not cover the individual rendering providers under it — each one needs their own NPI-1 enrollment. This is a common denial source for growing Texas practices, and we track it proactively for every new hire.
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