Houston Hospital Billing: Texas Medical Center Payers

Timely filing in Houston

Which dispute path applies to a Houston claim?

The plan type sets the path. The Texas rules are on the state page; this is the Houston short version.

Major payers

Which Houston health systems matter for billing, and what should you expect from each?

Four systems and one campus cover most of the Houston conversation: the Texas Medical Center campus, Memorial Hermann, Houston Methodist, Harris Health and Texas Children's. Each one states its own scale, and each one sits in a different mix of plan networks. The Texas Medical Center (TMC) is the shared campus, not a single payer or a single billing office.

The TMC website lists 750,000 ER visits per year and 10,000 total patient beds across the campus. The page carries no as-of date, so treat both as the TMC's own current claim rather than an audited count. This page does not rank the Houston systems by ER or outpatient volume.

The practical point is simple. A Houston claim has two parts that can sit in different networks: the facility and the physician group. Harris Health's own insurance page warns that its affiliated physician groups may not be contracted by certain insurance plans, and the same split exists across the other systems. Check both before you post an expected payment.

How does Harris Health change the payer mix in Houston?

Harris Health is the public system that serves low-income and uninsured residents of Harris County, so its accounts carry more Medicaid, Medicare and financial assistance cases than a typical private system. Its own About page says it has served Harris County since 1966. Ben Taub Hospital is its Level I trauma center, and the system states that Ben Taub is one of only two adult Level I trauma hospitals in Houston.

Harris Health publishes the plans it contracts with. The commercial names on that page include Aetna Health of Texas, Blue Cross and Blue Shield of Texas, Cigna Healthcare of Texas and UnitedHealthcare. The Medicaid managed care names include Community Health Choice, Molina Healthcare of Texas, Superior HealthPlan, Texas Children's Health Plan and UnitedHealthcare, alongside traditional Medicaid through TMHP. For Medicare it lists Traditional Medicare Parts A and B, Community Health Choice's D-SNP and Medicare private fee-for-service plans.

Its financial assistance program has rules that affect what is collectible. Harris Health states that household income may not exceed 150% of the Federal Poverty Level to qualify, that patients are asked for a minimum payment at the visit (except pediatric and prenatal visits), and that applicants who may be eligible for Medicaid, CHIP, Marketplace coverage and similar programs must apply for them. A patient with Medicare who applies must also submit a Medicare Asset Form.

For your own A/R, that means a self-pay Harris Health balance may be reclassified once a Medicaid or Marketplace application is filed. Track the application date, because the Texas Medicaid retroactive eligibility window runs from the add date and is covered on the Texas page.

What did the Memorial Hermann and Blue Cross of Texas contract notice say?

Blue Cross and Blue Shield of Texas (BCBSTX) posted a notice dated January 28, 2026 saying its contracts with Memorial Hermann would expire on April 1, 2026. It said that without an agreement, Memorial Hermann hospitals, facilities, doctors and health care professionals would leave five commercial networks: Blue Choice PPO, Blue Essentials, Blue Advantage HMO, Blue Premier and BlueHPN. The same notice says Memorial Hermann left the BCBSTX Medicare Advantage networks on January 1, 2026.

Because the contract date has passed, check the BCBSTX Memorial Hermann page and your payer portal before you quote a network status for a Houston date of service.

The notice also describes what happens to members mid-treatment. BCBSTX says commercial member notices mail at least 30 days before the termination date, and members treated for a disability, acute condition or life-threatening illness may qualify for continuity of care at in-network rates. If a patient presents with that situation, ask the plan for the continuity-of-care approval and keep it with the claim.

Emergency claims are a separate question. For a fully insured plan, an out-of-network emergency claim at a facility follows the Texas mediation route covered below, so a network lapse changes the payment dispute path, not the patient's emergency access.

Does a Houston facility use TDI mediation or federal IDR?

It depends on the plan, not on Houston. A fully insured plan regulated by the Texas Department of Insurance (TDI) sends a facility's out-of-network emergency claim to Texas mediation under Insurance Code Chapter 1467, Subchapter B. A self-funded employer plan sits outside that law and follows the federal No Surprises Act process, including federal IDR.

Full detail on deadlines, covered services and the arbitration route for physicians is on the Texas page and in the state surprise billing law guide.

For a Houston ER group, the working step is to sort every underpaid claim by plan type on day one. The member ID card, the payer's remittance and the plan's funding status decide the pathway, and a wrong guess burns the filing window.

How do Houston hospitals bill one ER visit on UB-04 and CMS-1500?

The hospital bills its facility charges on the UB-04 and the emergency physician group bills professional services on the CMS-1500. They are two claims with two billing NPIs, two payer adjudications and, as noted above, sometimes two different network statuses. The hospital and group are paid separately, and one can be in network while the other is not.

In Houston this matters most at the large teaching campuses, where physician groups are often separate from the hospital entity. Match the group's contract list to the plan before the claim drops. Our emergency medicine billing and hospital and facility billing pages cover the two claim types in depth.

Which Medicaid and Medicare rules apply to a Houston patient?

Houston patients on Medicaid are billed through TMHP or a managed care plan, and Medicare Part A and B claims go to Novitas Solutions in Jurisdiction H. The filing limits are the Texas ones: 95 days for Medicaid and one calendar year for Medicare, both laid out on the Texas page. Learn the general rules on our Medicaid and Medicare guides.

To see which Medicaid managed care plan a Houston patient has, check eligibility in TexMedConnect or the Automated Inquiry System before billing, as the TMPPM directs. Use Harris Health's published plan list above only as a starting point and confirm the plan on the eligibility response.

How we handle billing for Houston groups and facilities

We serve Houston groups and facilities remotely. Our only US office is the registered office in Richmond, KY, and we have no office or staff in Houston.

For out-of-network work we manage reimbursement end to end: eligibility assessment, open negotiation, dispute submissions, deadline management, documentation validation and outcome tracking, under federal IDR and applicable state pathways, including Texas TDI. For hospitals and facilities we prepare UB-04 claims, validate revenue codes, submit, reconcile payments and manage denials, with claims sent within 24 hours of charge entry and denials worked within 48 hours.

If you want your Houston network statuses and open-negotiation deadlines checked against your open A/R, book a call.