Gastroenterology Billing Services in Texas for Cleaner GI Claims
- Texas Medicaid and CHIP eligibility checks across STAR, STAR+PLUS, and STAR Kids MCO plans.
- SB 1264 surprised billing compliance with TDI arbitration filing for out-of-network GI claims.
- HHSC and TMHP-aligned claim submission inside the 95-day Texas Medicaid filing window.
- Screening-to-diagnostic colonoscopy coding with modifier 33 and PT applied correctly.
- AI-driven prior authorization for capsule endoscopy, biologics, and surveillance procedures.
- Procedure-level dashboards tracking first-pass clean claim rate, ASC facility collections, and A/R by payer.
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Which Texas Billing Regulations Does Transcure Handle?
Transcure handles SB 1264 surprise billing rules, Texas Medicaid claims under HHSC, prompt-pay enforcement, and HB 300 privacy compliance. These four rules trigger most GI denials, penalties, and audit flags in Texas, and we apply each one before a claim goes out.
SB 1264 Surprise Billing
SB 1264 and Insurance Code Chapter 1467 bar balance billing on state-regulated plans when the patient had no choice of provider. We file out-of-network endoscopy and anesthesia disputes through TDI arbitration. Your practice collects the fair rate without billing the patient.
Texas Medicaid (HHSC + TMHP)
Texas Medicaid runs through HHSC and processes claims via TMHP and TexMedConnect. We handle eligibility, prior authorization, and appeals across STAR and STAR+PLUS managed care plans. Every GI claim reaches TMHP inside the strict 95-day filing window.
Texas Prompt Pay Act
Under Insurance Code §843.338 and §1301.103, insurers must pay clean electronic claims in 30 days and paper claims in 45. We track every overdue GI payment and file penalty demands under §843.342. Your practice recovers the interest that late payers would otherwise keep.
HB 300 Patient Privacy
HB 300 and Health & Safety Code Chapter 181 widen patient privacy duties beyond HIPAA to a broader set of Texas entities. Our billing infrastructure meets the stricter state breach and disclosure standards. Your GI records stay protected at every claim touchpoint.
How Transcure Cuts Denials and Speeds A/R in Texas/?
Two pressures drain Texas GI revenue: screening-to-diagnostic coding errors and prior authorization lag on biologics and capsule studies. The Transcure RCM services platform is built for Texas payer rules, not a generic template. That is what makes us a trusted medical billing services in Texas for gastroenterology.
Serving Healthcare Providers Across All Major Maryland Cities
Transcure assigns dedicated Maryland billing specialists familiar with your city’s dominant payer mix, referral networks, and local Maryland Department of Health district offices. We provide comprehensive medical billing support across all Maryland cities, including:
Houston, TX
San Antonio, TX
Dallas, TX
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Austin, TX
Fort Worth, TX
El Paso, TX
Arlington, TX
Corpus Christi, TX
Plano, TX
What's Changed in Gastroenterology Billing for 2026?
2026 updates reshape gastroenterology billing in Texas, such as new CPT codes, the G2211 add-on, stricter screening rules, and tougher audit documentation. Gastroenterology practices must apply these updates for accurate claim submissions.
CPT 2026 adds permanent codes for endoscopic sleeve gastroplasty (43889) and liver tumor electroporation (47384). New anorectal manometry codes 91124 and 91125 replace deleted 91120 and 91122.
Gastroenterologists can now report add-on code G2211 with outpatient E/M for longitudinal conditions. We attach it to IBD, hepatitis C, and cirrhosis visits where the documentation supports it.
Trusted Billing Support Across High-Volume and Rural Maryland Counties
Maryland has 23 counties, each with distinct HealthChoice MCO participation rates, local health department structures, and commercial payer penetration. Transcure has billing experience across every Maryland jurisdiction, from high-volume Montgomery to Cecil County. We cover all Maryland counties, including:
Harris County, TX
Dallas County, TX
Tarrant County, TX
Bexar County, TX
Travis County, TX
Collin County, TX
Denton County, TX
Fort Bend County, TX
Hidalgo County, TX
Common GI Procedures in Transcure's Billing Scope
Transcure bills the full range of GI procedures, from routine diagnostic endoscopy to interventional ERCP and EUS. These six categories carry most daily GI claim volume, and we code each to its own modifier and payer rules.
Colonoscopy Billing
Screening, diagnostic, and interventional colonoscopies are billed across 45378 through 45393. Modifiers 33 and PT handle screening-to-diagnostic conversion, and modifier 53 covers incomplete exams. Polypectomy, biopsy, and ablation each post at full procedure value.
Capsule Endoscopy Billing
Capsule studies 91110, 91111, and 91113 are billed with the technical and professional components split correctly. Prior authorization is secured before ingestion, with supporting clinical evidence attached. Small bowel and colon capsule claims are clear on first submission.
Upper GI Endoscopy (EGD) Billing
Every billable EGD component is captured across 43235, 43239, 43249, and 43255. The multiple endoscopy reduction rule is applied, so each technique posts its correct allowable. Biopsy, dilation, and bleeding control are coded and paid separately.
Flexible Sigmoidoscopy Billing
Diagnostic and therapeutic sigmoidoscopy is billed across 45330, 45331, and 45333, plus Medicare screening code G0104. Modifier 52 covers reduced or incomplete exams. We clear claims on the first pass across commercial and Medicare plans.
ERCP Billing
ERCP base and add-on codes 43260 through 43278 are sequenced in the correct billing order. Authorization is verified first, and documentation supports each sphincterotomy, stone removal, and stent placement. We make sure every billable component posts correctly.
Endoscopic Ultrasound (EUS)
Diagnostic and interventional EUS is billed across 43237, 43259, 43238, and 43242 fine-needle work. Documentation is structured to meet medical necessity for staging and tissue sampling. The EUS and FNA claims hold up across all major payers.
OUR Certifications
With industry-recognized certifications such as HIPAA and AAPC, Transcure’s Gastroenterology billing team helps ensure claims comply with CMS requirements and individual payer coding standards.
What Makes Transcure a Leading Texas GI Billing Partner?
Transcure is the best medical billing company in Texas for gastroenterology because we provide the following to GI practices across the state.
We monitor HHSC, TMHP, the Texas Department of Insurance, and the Texas Legislature for every GI billing rule change. Protocols update before a rule takes effect, not after a denial lands on your desk.
ELIXA verifies eligibility, PRIA clears prior authorization, CODIN handles GI coding, and DEXA recovers denials. Together, they hold a 99% first-pass clean claim rate across Texas Medicaid, Medicare, and commercial plans.
Texas Provider Enrollment
We manage CAQH profiles and Texas Medicaid enrollment through the TMHP PEMS portal. Payer-specific GI credentialing and re-credentialing deadlines are tracked, so no claim lapses for an expired enrollment.
Certified Texas Billing Specialists
Our billers hold CPC, CCS, and CPMA certifications with annual training on TMHP rules, SB 1264, HB 300, and GI procedure coding. They know endoscopy edits before payers apply them.
Dedicated Texas Denial Recovery Team
Our dedicated team targets the top Texas GI denial patterns: screening-to-diagnostic errors, frequency edits, NCCI bundling, and anesthesia rejections. Root-cause analysis by payer drives an appeal success rate above 80%.
Texas Payer Contract Analysis and Underpayment Recovery
We analyze GI fee schedules across BCBSTX, UnitedHealthcare, Aetna, Cigna, and Humana to flag underpayments. Endoscopy contract gaps are identified, and renegotiation is supported to lift the collected revenue.
We track GI claim status around the clock with real-time alerts on Texas payer payment delays. Every practice gets a dedicated account manager with a same-business-day response commitment.
How a Texas GI Practice Improved Collections with Transcure?
When Transcure took over medical billing for DDS Medical, their 120+ day AR balance was $4,938,717. The problems were clear: claims were never sent to insurance, authorizations were missing, and unworked claims had aged past timely filing limits. On top of that, payments physicians had already received were never recorded, so those claims looked unpaid when they were not.
We fixed this by filing appeals, correcting authorizations, following up on clearinghouse rejections, and reconciling posting. As a result, we brought the 120+ day AR balance down to $1,269,489.
For their GI client, the same providers and the same patient volume brought in 20% more revenue through cleaner billing and AR recovery, raising monthly collections from $1M to $1.2M. The daily denial rate dropped from 20% to under 2%. Every recovered payment was reported back to the physicians, confirming that accounts they had given up on were actually collected.
Dr Ghulam Mujtaba
Premier Digestive Care
Working with Transcure Medical Billing Services has been a game-changer for Digestive Disease Specialists. Their professionalism and expertise in medical billing have helped us maximize reimbursements and reduce claim denials. Their team is responsive and always ready to address our concerns. We highly recommend Transcure Billing Services for their reliable and efficient service.
Which Gastroenterology EHRs Transcure Supports in Texas?
Our team is trained in all major GI EHR platforms such as ModMed, NextGen, and eCW. So, you never have to switch systems to work with Transcure.
Jackie Judd
Practice Manager
Wilson Creek Internal Medicine
As a practice manager, I was looking to streamline the medical billing process. I tried other companies, but they were all complicated and took too much of my time. Fortunately, I found Transcure. They excel in tailoring solutions to fit my requirements.
Amber Vaughan
Office Manager
Idaho Kidney & Hypertension Institute
We are a large practice with 15 providers. Transcure has been working with us for the last 5 years. This billing company has been a great asset to us. I work with Transcure and they provide everything I ask for. The team is friendly and very pleasant to work with.
Ashlee Rose
Practice Manager
Harding Memorial Healthcare
We’ve been working with Transcure for 8 years now and I just wanted to say how happy we are with their services. They always get back to us quickly and are very easy to work with. They get my bills paid in record time and help us to generate millions in revenue.
Trusted by Texas Providers Statewide
Transcure is rated highly by healthcare providers across the major review aggregators.
Frequently Asked Questions About Gastroenterology Billing Services in Texas
Get answers to the most common questions Texas GI providers ask about our billing services, compliance, and Texas-specific regulations.
How does SB 1264 restrict balance billing for Texas gastroenterology providers?
SB 1264 bars out-of-network providers from billing state-plan patients the balance when those patients had no provider choice. Endoscopy and anesthesia claims on emergency or facility-assigned cases fall under this rule. Disputes go to TDI baseball-style arbitration, where we file billed-charge evidence to win the reasonable rate.
What does Transcure do to stay current with Texas Medicaid billing requirements?
We track every TMHP bulletin and HHSC rate change as it publishes, then update GI coding protocols the same week. Certified billers handle eligibility, prior authorization, and appeals across all STAR managed care plans. Each colonoscopy and infusion claim is submitted well inside the 95-day filing window.
Why do Texas gastroenterology practices choose Transcure over other billing companies?
Practices choose us because we bill GI procedures, not generic claims, with screening-to-diagnostic accuracy built in. ELIXA, PRIA, CODIN, and DEXA run eligibility, authorization, coding, and denials end-to-end. CPC and CCS-certified specialists hold first-pass clean claim rates at 99% across Texas payers.
What does the onboarding process look like for a Texas practice joining Transcure?
Most Texas GI practices are billing through Transcure within 5 to 7 business days. Our team runs EHR integration, TMHP enrollment verification, CAQH credentialing, and payer workflow setup in parallel. There is no gap in claim submission, so cash flow continues from day one.
How long does Texas Medicaid give gastroenterology providers to submit a claim?
Texas Medicaid sets a hard 95-day filing window from each date of service, with appeals due within 120 days. STAR managed care plan windows vary by MCO contract. We track every GI claim against its specific deadline so no scope or infusion claim ages out.
What happens if a Texas practice fails an HHSC OIG audit?
A failed HHSC Office of Inspector General audit can trigger repayment demands, civil penalties, or Medicaid exclusion. GI surveillance frequency and medical necessity documentation are common audit targets. We keep coding tied to payer rules and maintain audit-ready records so your practice withstands review.
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