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No Surprises Act IDR in Texas

IDR filing for Texas providers: which claims go federal, which go state

Texas generates more No Surprises Act disputes than any other state — federal and state combined. Whether a claim goes to federal IDR or the Texas Department of Insurance process depends on who regulates the plan.

Federal IDR or the Texas state process?

Texas is a bifurcated state. Its surprise-billing law (SB 1264, 2019) created a state mediation and arbitration system run by the Texas Department of Insurance for out-of-network claims under state-regulated plans: fully insured employer coverage, individual and marketplace plans, and certain state employee and teacher plans. Claims under self-funded ERISA employer plans go to the federal IDR process.

The rule of thumb in every bifurcated state: the state law governs plans the state regulates (fully insured employer plans, individual/marketplace plans, and usually HMOs). Self-funded employer plans under ERISA — the majority of commercial coverage — go through federal IDR unless the plan has affirmatively opted into the state process where that's allowed. Getting this wrong is the #1 reason disputes are thrown out as ineligible.

What the numbers look like

  • Texas led the country in federal IDR initiations in 2023 and 2024 — more than 85,000 emergency/non-emergency disputes in Q4 2023 alone, roughly double the next state.
  • The Texas state process saw over 500,000 disputes initiated in its most recent reporting year; about two-thirds settled during the 30-day negotiation period without reaching arbitration.
  • Emergency medicine, anesthesia, and radiology groups in Houston, Dallas–Fort Worth, San Antonio, and Austin make up the bulk of volume.

What we do for Texas groups

  • Screen every OON claim for plan type and route it correctly — federal portal vs. TDI portal
  • Run open negotiation on both tracks with the correct clocks (federal: 30 business days + 4-day initiation window; state: TDI timelines)
  • Batch federal disputes by payer and code to keep per-claim fees down
  • Price offers using Texas-specific determination data

Not sure which process applies?

Send 90 days of out-of-network remits and we'll tell you claim by claim: federal IDR, Texas state process, or not disputable — plus what similar disputes have paid.

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Related

How the federal IDR process works
IDR data & benchmarks
Other states

Find out what your out-of-network claims are actually worth.

Send us a sample of recent OON remits. We'll tell you which claims are IDR-eligible, what similar disputes have paid, and what we'd file. No fee unless we win you more.

Request a free eligibility review