State IDR · TX
Texas out-of-network disputes
Arbitration for physicians and other providers; mediation for facilities.
Who it covers
Plans and services in scope
- State-regulated plans: HMOs, EPOs and PPOs regulated by TDI, plus the state employee and teacher plans.
- Emergency care, and out-of-network care at an in-network facility, for services on or after January 1, 2020.
- Facility claims for emergency care go to mediation rather than arbitration.
Timeline
- Day 20 after first paymentEarliest day to request arbitration through the TDI portal.
- Day 90 after first paymentLast day to request arbitration. Later requests are not eligible.
- 30 days after the requestInformal settlement period. TDI assigns an arbitrator if the parties have not agreed on one.
- Day 51 after the requestWritten decision due, unless both parties agree to extend.
How Revise handles it
The engine sorts each Texas claim into TDI arbitration, TDI mediation or federal IDR, tracks the 90-day window from first payment, and files through the TDI portal.
Fees
Arbitrator fees are set under TDI rules. Confirm the current schedule with TDI before filing.
Where federal IDR applies
Self-funded employer plans are not regulated by TDI, so their claims go to the federal process.
Other states
Send us one month of remits.
We’ll show you what you left on the table.
Seven business days. No cost. A line-by-line report of eligible claims you didn’t file, QPAs that don’t add up, and awards you were never paid.
Sources
- 11Texas Department of Insurance, SB 1264 and the independent dispute resolution process: request arbitration 20 to 90 days after first payment, 30-day informal settlement period, decision by day 51; facility claims go to mediation. Source