PPS has worked with hundreds of practices in Texas since 2008, when our third client was a nephrology practice in Dallas. We support physicians, advanced practice providers, therapists and facilities across the state with insurance credentialing, provider enrollment, insurance contract negotiations, practice start-up services, website design and general practice consulting. Each proposal is scoped to the work your practice actually needs.
Services for Texas practices
Credentialing & enrollment
Organize provider records, payer applications and enrollment follow-up.
Explore service 02 / Healthy foundationsPractice start-up
Bring your payer strategy, people and business decisions into an opening plan.
Explore service 03 / Payer relationshipsContract negotiations
Review agreements and prepare a practice-specific approach to negotiations.
Explore service 04 / Patient growthWebsite design & marketing
Connect your practice with patients through a clear website and online presence.
Explore serviceProvider & payer support
- Physician credentialing and insurance contracting
- Hospital credentialing and enrollment
- Nurse practitioner credentialing and start-up support
- Telemedicine credentialing
- Medicare individual, group and reassignment enrollment
- Texas Medicaid enrollment
- DMEPOS Medicare enrollment
- ERA and EFT enrollment
- Credentialing maintenance
Business & operations
- Practice consulting: budgets, financial projections, EHR selection and billing review
- Practice location analysis
- Therapy and group practice start-up services
- Online compliance training
- Employment manuals (paid resource)
- Business development and recruitment
- Branding, website design and search engine optimization
- Health review site submission and monitoring
Payer credentialing in Texas
Your payer strategy depends on your specialty, location and the patients you expect to serve. PPS can help evaluate participation opportunities and coordinate credentialing and enrollment across commercial plans, Medicare, Texas Medicaid and workers compensation networks. Confirm current network availability directly with each payer.
Texas Medicaid lists Medicare enrollment as a prerequisite when you render services for clients who are eligible for Medicare. Providers whose practice type will never serve Medicare-eligible individuals, such as pediatrics or obstetrics and gynecology, may request a Medicare waiver during enrollment, subject to state approval. Confirm the requirement for your provider type in the Texas Medicaid Provider Procedures Manual .
Use these official resources as a starting point:
Texas health plan market share
The table below lists health plan revenue reported to the State of Texas for 2017. Treat it as historical market context rather than a current ranking. Plan participation and network availability change, so confirm current options with each payer before you apply. PPS also works with workers compensation networks that may suit your practice.
| Rank | Plan code | Health plan | 2017 Texas revenue | Market share |
|---|---|---|---|---|
| 1 | 95314 | Amerigroup Texas, Inc. | $ 3,587,531,660 | 13.55 |
| 2 | 95647 | Superior Healthplan, Inc. | 2,895,471,630 | 10.93 |
| 3 | 95174 | Unitedhealthcare Benefits of Texas, Inc. | 2,648,815,703 | 10.00 |
| 4 | 12902 | Healthspring Life & Health Insurance Company, Inc. | 2,155,803,374 | 8.14 |
| 5 | 11141 | Unitedhealthcare Community Plan of Texas, L.L.C. | 2,139,513,211 | 8.08 |
| 6 | 10757 | Molina Healthcare of Texas, Inc. | 2,028,763,759 | 7.66 |
| 7 | 95024 | Humana Health Plan of Texas, Inc. | 1,943,930,342 | 7.34 |
| 8 | 70670 | BCBS of Texas, A Division of Healthcare Service Corporation | 1,105,310,107 | 4.17 |
| 9 | 95329 | Texas Children’s Health Plan, Inc. | 957,733,349 | 3.62 |
| 10 | 95615 | Community Health Choice, Inc. | 856,842,110 | 3.24 |
| 11 | 10096 | Selectcare of Texas, Inc. | 800,252,842 | 3.02 |
| 12 | 95099 | Scott and White Health Plan | 695,982,709 | 2.63 |
| 13 | 95414 | Parkland Community Health Plan, Inc. | 531,182,284 | 2.01 |
| 14 | 95490 | Aetna Health, Inc. | 522,532,780 | 1.97 |
| 15 | 95138 | SHA, L.L.C. | 515,696,030 | 1.95 |
| 16 | 95809 | Driscoll Children’s Health Plan | 436,279,530 | 1.65 |
| 17 | 11494 | Physicians Health Choice of Texas, Llc | 379,902,180 | 1.43 |
| 18 | 12964 | Wellcare of Texas, Inc. | 368,642,857 | 1.39 |
| 19 | 95248 | Community First Health Plans, Inc. | 361,807,743 | 1.37 |
| 20 | 12827 | KS Plan Administrators, LLC | 320,845,655 | 1.21 |
| 21 | 95822 | Cook Children’s Health Plan | 299,384,822 | 1.13 |
| 22 | 52635 | El Paso First Health Plans, Inc. | 191,167,342 | 0.72 |
| 23 | 95383 | Cigna Healthcare of Texas, Inc. | 84,170,480 | 0.32 |
| 24 | 95040 | Aetna Better Health of Texas Inc. | 79,458,779 | 0.30 |
| 25 | 95799 | Valueoptions of Texas, Inc. | 79,088,540 | 0.30 |
Supporting practices across Texas
We provide services to physicians and facilities across Texas. These are some of the cities where we have recently supported practice start-up and credentialing work:
- Abilene
- Allen
- Amarillo
- Arlington
- Atascocita
- Austin
- Baytown
- Beaumont
- Brownsville
- Bryan
- Carrollton
- Cedar Park
- College Station
- Conroe
- Corpus Christi
- Dallas
- Denton
- DeSoto
- Edinburg
- El Paso
- Euless
- Flower Mound
- Fort Worth
- Frisco
- Galveston
- Garland
- Georgetown
- Grand Prairie
- Grapevine
- Harlingen
- Houston
- Irving
- Killeen
- Laredo
- League City
- Lewisville
- Longview
- Lubbock
- Mansfield
- McAllen
- McKinney
- Mesquite
- Midland
- Mission
- Missouri City
- New Braunfels
- North Richland Hills
- Odessa
- Pasadena
- Pearland
- Pflugerville
- Pharr
- Plano
- Port Arthur
- Richardson
- Round Rock
- Rowlett
- San Angelo
- San Antonio
- San Marcos
- Spring
- Sugar Land
- Temple
- The Woodlands
- Tyler
- Victoria
- Waco
- Wichita Falls
Free credentialing checklists
These credentialing checklists are free, with no prerequisites. Choose the one that fits your situation:
- Provider credentialing checklist: for practices and organizations hiring a new provider with established payer agreements and locations.
- New practice credentialing checklist: for new practices that will obtain new payer agreements or enter a new market.
Free practice start-up checklist
Work through the checklist and timeline so nothing is missed or done out of order while you open your practice. It is free to any new practice that wants the guidance. We ask for a short validation step before sending it.
Free resources for your practice
Use these guides and templates to prepare your practice. Read resources online, download available files or request a copy by email.
- Practice start-up checklistsRequest by email →
- Medicare enrollment guideRead online →
- Medicare Wellness FormsRequest by email →
- Physician Employment AgreementRequest by email →
- HIPAA and Mental Health Information SharingRequest by email →
- Practice OSHA Safety Plan Practice KitRequest by email →
- Medicare bank letter templateView & download →