TMHP, the STAR plan, and a workers' compensation nonsubscriber are three different answers. The Health and Human Services Commission runs Texas Medicaid. Fee-for-service claims go to the Texas Medicaid and Healthcare Partnership. The September 2026 provider manual says TMHP must receive those claims within 95 days of each date of service, and appeals within 120 days of the disposition on the R&S Report. STAR, STAR+PLUS, and STAR Kids members are billed to their plan, not to TMHP.
TMHP, the STAR plan, and a workers' compensation nonsubscriber are three different answers.
The Health and Human Services Commission runs Texas Medicaid. Fee-for-service claims go to the Texas Medicaid and Healthcare Partnership. The September 2026 provider manual says TMHP must receive those claims within 95 days of each date of service, and appeals within 120 days of the disposition on the R&S Report. STAR, STAR+PLUS, and STAR Kids members are billed to their plan, not to TMHP.
Medicare Part A and Part B for a Texas practice go to Novitas Solutions, Jurisdiction H, with Oklahoma, Arkansas, Louisiana, and New Mexico. A managed-care Medicaid claim does not go to Novitas unless Medicare is primary.
Texas does not require most private employers to carry workers' compensation. If the employer is a nonsubscriber, there is no workers' compensation carrier to bill. Covered employers are billed under the Division of Workers' Compensation. The first question on a work injury is whether coverage exists.
A Texas Medicaid claim that waits in a coding queue can miss the 95-day TMHP window. That window is for fee-for-service. STAR plans publish their own limits. The plan manual is the one that is followed when the member is in managed care. Out-of-state providers have a different TMHP window, published in the same manual.
TMHP must receive it within 95 days of each date of service, under the current Texas Medicaid Provider Procedures Manual. STAR plan limits are the plan's, not TMHP's.
Texas allows nonsubscribers. There is no workers' compensation carrier to bill until coverage is confirmed.
The fee is a percentage of net collections. The written rate follows volume, specialty, and how much of the cycle you hand over. There is no setup fee, and the agreement is month to month. The state is not a surcharge. How pricing is set.
