IDR guide for Texas providers
Texas providers can face two dispute systems for the same kind of out of network claim. The health plan decides which one applies, and the rules, deadlines and fees are different in each.
Updated October 31, 2026
Federal IDR is the No Surprises Act process for plans that Texas does not regulate, mostly self funded employer plans. Texas IDR is the state process under SB 1264 for plans regulated by the Texas Department of Insurance. Federal IDR uses baseball style arbitration, where a certified entity picks one of two offers. Texas uses binding arbitration for physicians and other providers, and mediation for facilities such as freestanding ERs. A claim must go down the route that matches the plan, or it can be found ineligible.
The key differences side by side.
| Feature | Federal IDR | Texas IDR |
|---|---|---|
| Law | No Surprises Act, for services on or after January 1, 2022 | Senate Bill 1264, for services on or after January 1, 2020 |
| Plans covered | Mostly self funded ERISA plans, plus plans with no applicable state law | Fully insured plans regulated by TDI, ERS, TRS and self funded plans that opted in |
| Services | Emergency care, certain services at in network facilities, air ambulance | Emergency care, certain services at in network facilities, related lab and imaging |
| Process | Baseball style: the entity picks one of two offers | Arbitration for providers (binding) and mediation for facilities |
| Starting the dispute | 30 business days of open negotiation, then 4 business days to start IDR | Arbitration 20 to 90 days after first payment, mediation 20 to 180 days |
| Decision timing | Within 30 business days after the IDR entity is selected | Arbitration decision by day 51 |
| Fees | $15 administrative fee per party for disputes started on or after June 11, 2026, plus an entity fee paid by the losing side | Arbitrator sets a fixed fee per case, split equally between the parties |
| Grouping claims | Batching of similar items, up to 50 items per batch under the 2026 rule | Multiple claims with the same plan up to $5,000 in one arbitration request |
Start with the plan, not the provider or the service. Ask three questions:
The remittance advice helps too. Under the 2026 federal rule, plans must use standard codes that say whether a claim is subject to the No Surprises Act. We still confirm with the plan before filing, because a dispute filed on the wrong route can be thrown out and the deadline lost.
Federal IDR: each side submits one payment offer. The certified IDR entity looks at the qualifying payment amount (QPA), which is generally the plan median contracted rate, along with other information such as provider training, patient acuity and past contracting. Anesthesia claims follow the same rules with their own QPA method. It must choose one offer in full, so a well supported, realistic offer matters more than a high one.
Texas arbitration: the arbitrator weighs ten factors set by TDI, including the 80th percentile of billed charges and the 50th percentile of in network rates for the same service, specialty and area in the FAIR Health database, plus case complexity and any offer made during the settlement call. Most Texas cases never reach a decision: TDI reports 782,679 arbitration requests settled in the first 30 days from 2020 to October 2025.
Texas mediation: a mediator helps the facility and the plan reach an agreement. It is not a binding decision, so preparation and a clear payment history are key. Freestanding ERs can read our guide to freestanding ER billing in Texas.
Each of these can end a claim before anyone looks at the payment.
Send us a few underpaid claims. We will tell you which ones go to Texas IDR, which go to federal IDR, and the deadline for each.
Tell us about your practice and a billing specialist will contact you.
