- 4009 Hackney Springs Ln, Sachse, TX 75048
Master Texas Medicaid, Medicare, BCBS TX & 180+ Commercial Payer Requirements
Slash Claim Denials by 35% with CPT/HCPCS Code Precision
Navigate Texas's Aggressive Managed Care Environment
Post Payments in 24-48 Hours, Zero Revenue Bottlenecks
Recover Outstanding A/R in 26 Days -48% Faster Than Industry Average
| Medicare Administrative Contractor (MAC) | Jurisdiction Code | MolDX Program Participant |
|---|---|---|
| Novitas Solutions | Jurisdiction H (JH) | No (Independent LCDs) |
Texas represents one of the nation’s largest laboratory markets, operating under Novitas Solutions Jurisdiction H, which does not participate in MolDx, so molecular tests bill with standard CPT/ICD-10 coding rather than a Palmetto Z-Code. JH carries the highest historical rate of lab billing fraud enforcement of any jurisdiction, making written drug-testing protocols, physician sign-off records, and clear chain-of-custody documentation essential for every urine drug testing (LCD L34752) claim Texas labs submit.
First-pass clean claim rates of 98%
Denial rates below 3%
Days in A/R reduced from 78+ days to under 21 days
Overall revenue improvement of 8-12%
Denials reduced by 35%
AAPC/AHIMA certified coders ensure precise CPT, ICD-10, and HCPCS code assignment across all laboratory specialties. Accurate coding reduces denials, accelerates payments, and keeps your lab fully compliant with evolving payer requirements
Complete payer enrollment, CLIA certification management, and network participation setup across all insurance carriers. TransLabs manages every credentialing detail so that your laboratory gets paid in-network from day one without any administrative delays.
Real-time insurance verification, benefits investigation, and prior auth completed before specimen processing begins. Confirming coverage upfront eliminates preventable denials and protects your lab from unexpected reimbursement failures.
Patient registration, appointment coordination, insurance verification, and customer service excellence managed by experienced laboratory billing professionals. A well-run front office reduces downstream billing errors and creates a better experience.
Our labs billing services adhere strictly to CMS Laws and HIPAA guidelines
Claims checked against Novitas Solutions's local coverage rules before submission.
Texas Medicaid prior-auth rules built into your workflow, not discovered after denial.
Appeals strategy built around Texas's actual payer mix.
A single point of contact who knows your account.
Onboarding in 24 hours; no long-term contract.
TransLabs specializes exclusively in Texas laboratory facilities, giving us unmatched expertise in Texas Medicaid MCO requirements, BCBS Texas policies, Medicare Administrative Contractor (MAC) Jurisdiction H (JH) coverage determinations, and Texas-specific payer regulations. Our 98% first-pass clean claim rate and 99% client retention rate reflect our commitment to excellence.
Texas’s statute of limitations for medical billing is generally four years from the date of service. However, insurance companies have much shorter filing deadlines typically 90 to 180 days for commercial payers, 365 days for Medicare, and 95 days for Texas Medicaid. Missing these deadlines forfeits your right to payment, which is why timely claim submission is critical.
The top five denial reasons are:
Yes, but requirements vary by MCO and service delivery area. Most MCOs require prior authorization for molecular diagnostics, genetic testing, tests over $500, and specialty immunology panels. Authorization timelines range from 5-30 days depending on MCO and clinical complexity. TransLabs manages authorizations across all Texas Medicaid MCOs to ensure approvals are secured before testing begins.
A Local Coverage Determination (LCD) is a Medicare policy that defines which tests are covered, which ICD-10 codes support medical necessity, and testing frequency limitations. Texas falls under Medicare Administrative Contractor (MAC) Jurisdiction H (JH), administered by Novitas Solutions, which has specific LCDs that differ from other regions. Billing a test with a non-covered diagnosis code results in automatic denial and potential audit exposure.
