Texas gives most claims 95 days. We work what's still inside the window, flag late payments the insurer owes penalties on, and are paid on what comes back.
“I appreciate that you did an audit and found out the root causes of a lot of my problems which are preventable.”
Not sure where your balances stand? Start with a free audit.
Texas payers
A Texas practice is paid by Medicare through Novitas, by Texas Medicaid through TMHP or a managed care plan, by commercial plans the Texas Department of Insurance (TDI) regulates, by self-funded employer plans it doesn't, by workers' comp carriers, and by TriWest for TRICARE. Most run a 95-day clock, and aged AR is recovered by working each balance against the rule that governs it.
Texas Part A and Part B claims go to Novitas Solutions, which CMS re-awarded the Jurisdiction H contract in June 2026. Claims must be filed within 12 months of the date of service. The same contractor pays claims in Colorado, also in Jurisdiction H.
Source: CMS, JH award, June 2026 · 42 CFR 424.44
Fee-for-service claims go to TMHP, and managed care claims to the member's STAR or other plan. From the Texas Medicaid Provider Procedures Manual:
HHSC's Uniform Managed Care Manual holds managed care claims to the same 95 days, with 120 days to appeal from the date of disposition.
Source: TMPPM Vol. 1, Section 6 · HHSC UMCM 2.0
PPO and EPO plans fall under Insurance Code chapter 1301, and HMOs under chapter 843.
"TDI" or "DOI" on the front of the ID card means TDI regulates the plan. TDI says most people with a health plan in Texas have a self-funded plan, which federal law governs and these rules don't reach, as the Fifth Circuit held for Aetna's self-funded ERISA plans in an unpublished 2016 opinion. Medicaid, CHIP and Medicare Advantage plans are exempt too.
Source: Ins. Code 1301.102 · 843.337 · 1301.137 · 843.342 · 28 TAC 21.2806 · TDI prompt pay FAQ · TDI · Aetna v. Methodist, 5th Cir. 2016
Exemptions apply only to plans TDI regulates, are granted at the issuer level, and don't extend to that issuer's Medicaid or Medicare Advantage plans. Check an exempt physician's preauthorization denials against the exemption.
Source: TDI, HB 3459 FAQ
Claims are due to the carrier within 95 days of the date of service, or the right to reimbursement is forfeited. Exceptions are in section 408.0272.
Source: Labor Code 408.027 · 408.0272
Texas moved from the TRICARE East Region to the West Region, run by TriWest, on 1 January 2025. Check for TriWest claims left unpaid by the switch.
Source: TRICARE, contract transition FAQ
Engagement
The method is the same everywhere; see how AR recovery works. What changes in Texas is how short the clocks are and when each one starts. We work remotely, inside the EHR you already use.
Claims are sorted by time left on their own filing clock first, because that clock decides what is still workable: 12 months for Medicare, 95 days for Medicaid, TDI-regulated plans and workers' comp.
Denied Medicaid claims are sorted by days since the disposition date on the R&S Report, so appeals go in inside 120 days, and zero-paid claims still inside 95 days go back as new claims.
A secondary claim's 95 days is counted from the primary payer's payment or denial notice, not the date of service, so the notice date is recorded for each one.
Once the ID card confirms a plan is TDI-regulated, clean claims paid after 30 days (electronic) or 45 (paper) are flagged for the statutory penalty.
If a physician holds an exemption from the issuer, preauthorization denials for the exempt service are pulled for review.
Comparison
A process comparison drawn from one engagement outside Texas. Not a record of a Texas practice and not a promise of outcome.
| Area | Before | With Quilven |
|---|---|---|
| Rejection ownership | No one owned the rejection queue, and rejected claims sat for most of a year. | Rejections are worked within four to five days, while each claim is still inside its 95 days. |
| Coordination of benefits | The patient's other coverage was never updated, so the same claims kept denying. | Other insurance is confirmed with the patient, and secondary claims are timed from the primary payer's notice. |
| Payer routing | Claims went to a parent plan when a subsidiary with its own claims unit was the payer. | Medicaid claims go to TMHP or the member's managed care plan, as enrollment requires. |
| Eligibility | Patients were seen on coverage that had ended, and the claims went out anyway. | Eligibility is checked before the visit, and retroactive eligibility claims go in within 95 days of the add date. |
| Member and group IDs | A mistyped member ID stayed in the record for months. | Demographic fields are matched to the payer's record before the claim is sent. |
| Lab claim attribution | The group NPI sat where the ordering physician's belonged, and the CLIA level didn't match the code. | The ordering physician's NPI is in box 17, and the CLIA level fits the code billed. |
| Modifiers | Waived tests went out without QW, and 25, 59 and RT were missing where they applied. | Modifiers are checked by code family before the claim goes out. |
| Timely filing | Rejections surfaced months later, with no proof the claims had ever been filed. | Each claim's 95-day clock is tracked from the correct start date, including primary-payer notices for secondaries, and proof of submission is kept. |
Which of these applies to your claims is a question the audit answers.
Deadlines
A Texas claim is recoverable while its window is open, or if you can prove it was filed on time. With 95 days as the default, most of the work is knowing when each window starts: the date of service, the primary payer's notice, completed enrollment or the R&S disposition date. See which Texas claims are still inside 95 days.
| Rule | Deadline | Source |
|---|---|---|
| Medicare | 12 months from date of service | 42 CFR 424.44 |
| Texas Medicaid | 95 days from each date of service | TMPPM Vol. 1 §6.1.4; UMCM 2.0 for managed care |
| Texas Medicaid appeal | 120 days from the R&S disposition date | TMPPM Vol. 1 §6.1.4 |
| Commercial (TDI-regulated) | 95 days from date of service, or payment is forfeited | Tex. Ins. Code 1301.102, 843.337 |
| Commercial secondary | 95 days from the primary payer's notice | 28 TAC 21.2806 |
| Clean claim payment | 30 days electronic, 45 paper | Tex. Ins. Code 1301.103, 843.338 |
| Workers' comp | 95 days from date of service | Tex. Labor Code 408.027 |
Last checked: 23 Oct 2026
You can run your claims against these deadlines in the browser, with no patient data.
Case study
One AR recovery engagement, at a family medicine practice in Minnesota, not Texas. Shown for method. Individual results vary. One engagement is not a forecast.
The engagement covered 245 claims. No one had been assigned the rejection queue, and close to a year of rejections had collected there.
Found: an estimated $40,000 to $50,000 in billed charges, never worked.
Most of the denials started at intake, with out-of-date coverage, mistyped member IDs and skipped eligibility checks.
A short payer window had already closed on most of the affected claims, and without proof of submission there was no appeal to make. In Texas, 95 days is the default for Medicaid, TDI-regulated plans and workers' comp, so that risk is the norm, not the exception.
Recovered: about $5,500, paid on 50 to 55 claims, mostly within 45 to 50 working days.
I appreciate the professionalism, the courtesy, the knowledge.
What you have provided for me was a detailed of things that are going wrong that needed to change in our practice.
I appreciate that you did an audit and found out the root causes of a lot of my problems which are preventable.
Pricing
Same pricing as every Quilven engagement, with nothing Texas-specific. See how every Quilven service is priced.
12 to 15%
of the recovered amount
No fee on what is not recovered. Where a practice lands in the range depends on claim volume, age of the inventory, and payer mix.
3 to 5%
of collections by monthly volume
A $500 monthly minimum applies. The rate moves with monthly volume, not with headcount on your side.
$150 to $200
per payer application
$200 per application, or $150 each for 8 or more. Can be included in a custom package for billing clients. Payer and state fees are paid by the practice.
Fit
Recovery work does not require a system swap. We integrate with 30+ EHRs and practice management systems and work inside the one you already have. No data migration, no parallel system, no change to how your staff enters a charge or checks a patient in. If your team is trained on your current software, that training stays valid.
This matters because the usual objection to outside AR help is that it turns into an implementation project. It does not here. Quilven is a managed service, not software. There is no proprietary platform you are asked to adopt and no license to renew, so the engagement can start on your existing inventory rather than after a build-out.
What you do get is visibility. Apex is our client dashboard, and it shows in real time:
Apex reads the work we are doing in your system. It is a window, not a replacement, so if the engagement ends your records and workflows are exactly where they were.
Company
Quilven is a managed revenue cycle service. Not software, not an EHR, and not a proprietary platform you have to adopt. We work inside the system your practice already uses, across 30+ integrations, with no data migration and no workflow change. Our clients are independent practices with 3 to 25+ providers.
Pricing is straightforward. AR recovery is 12 to 15 percent of the recovered amount. Medical billing is 3 to 5 percent of collections by monthly volume, with a $500 monthly minimum. Credentialing is $150 to $200 per payer application.
The entry point is a free RCM audit. It takes 48 hours and returns a line-by-line recoverable revenue estimate by payer, so the first thing you get from us is a diagnosis you can act on with or without us.
We lead with method and evidence rather than tenure. Quilven was founded in 2025 by Raief Shick. QUILVEN, LLC is registered in Wyoming, with its principal office at 1603 Capitol Ave, Cheyenne, WY 82001. Reach us at (202) 490-9406 or info@quilven.com.
Quilven has no Texas office. Work for a Texas practice is done remotely, inside the practice's own EHR.
Fit
Independent Texas practices with 3 to 25+ providers that have Medicaid, commercial or workers' comp claims aging toward their 95 days, and no one with the time to keep each claim inside its window.
If the backlog is a one-time problem, you can clear an aged backlog in one project instead of an ongoing engagement.
It is not for hospitals billing facility claims.
At a glance
FAQ
Next step
The audit takes 48 hours and returns a line-by-line recoverable revenue estimate by payer, plus the repeating root causes behind your denials. We only need aging totals to begin. No patient data, no contract, no obligation to work with us afterward. If your aging is healthy we will tell you that.
Answer three questions below and book a line-by-line audit of your Texas claims.
Where is the money leaking right now?
Pick the one that hurts most. We start there.
How old is your oldest unpaid claim?
A round number is fine. We verify it in the audit.
How big is the practice?
Just you, or a group. Either is welcome.
Last bit — where do we send the report?
No patient data. We only need aging totals to start.
(202) 490-9406 · info@quilven.com · Book 15 minutes
Your revenue cycle is run by named people with real credentials, not an anonymous queue. Named leads and their certifications are introduced during onboarding, with photos and direct contacts.
Owner
A long-time business owner who has built and run companies in recruitment and e-commerce before Quilven.
Client Partnerships Lead
Leads business development, working with U.S. healthcare providers and medical practices from first conversation to signed agreement.
Head of Growth
Runs Quilven's marketing, SEO and Google Ads. Full-time in SEO since 2022.
Client Solutions Director
Works with medical practices on denials, credentialing and full-cycle revenue cycle work. A registered nurse before moving into revenue cycle.
Behind every account
One person owns your account, knows your practice and is your single point of contact.
Coders holding CPC and COC credentials, with coding experience across the specialties we serve.
Provider enrollment and recredentialing, handled by people who work payers and panels every day.
Analysts who work aged AR and appeals on a set cadence, by code, until each claim resolves.