Freestanding ER billing
ZanexMed handles freestanding ER billing for Texas emergency centers: clean facility and physician claims, denial follow up, and recovery of underpaid out of network claims through TDI mediation, arbitration and federal IDR.
Updated October 31, 2026
Freestanding ER billing is the coding, claim submission and payment follow up for an emergency room that is licensed separately from a hospital. A freestanding ER usually sends two claims for each visit: a facility claim for the emergency center and a professional claim for the emergency physician. In Texas most freestanding ERs are out of network, so a large part of the work is fighting underpaid claims through Texas Department of Insurance mediation, physician arbitration, or federal IDR under the No Surprises Act.
Texas is home to more than half of the freestanding ERs in the United States, and freestanding ERs account for nearly 70 percent of out of network emergency facility claims in the state, according to the Texas Association of Health Plans.
That out of network status shapes everything. Payers often pay the facility claim far below billed charges, price the visit as urgent care, or deny it as not a true emergency. Each response needs a different fix: a coding review, an appeal with the medical record through denial management, or a payment dispute through Texas IDR or federal IDR.
Texas law and the federal No Surprises Act both protect the patient from a balance bill for emergency care. The dispute is between the ER and the health plan, which is why the right dispute route matters so much.
The two claims from one visit follow different rules in Texas.
| Claim | Who bills | Texas dispute route | Request window |
|---|---|---|---|
| Facility claim | The freestanding emergency center | TDI mediation | 20 to 180 days after the first claim payment |
| Professional claim | The emergency physician or group | TDI arbitration (binding) | 20 to 90 days after the first claim payment |
| Self funded plan claim | Facility or physician | Federal IDR, unless the plan opted in to Texas | 30 business days of open negotiation, then 4 business days to start IDR |
Sources: Texas Department of Insurance, 2025 and the federal No Surprises Act rules.
Freestanding ERs are the largest users of the Texas facility dispute process.
811,431
Mediation requests filed by freestanding ERs
72.9%
Share of all Texas mediation requests
745,305
All Texas mediation requests (every facility type) settled in the first 30 days
Texas Department of Insurance data, January 2020 to October 7, 2025. Source
One team covers the clean claim and the dispute, so nothing falls between billing and recovery.
Certified coders assign the right ER level, procedures and facility codes for every visit.
Facility and professional claims are scrubbed and sent with the right payer details.
We compare each payment with billed charges and the plan rules to flag underpayments.
Not a true emergency and level downgrade denials get an appeal with the medical record.
We choose the Texas or federal route and file inside the window.
Every agreement and decision is followed until the money is posted.
Most of these can be fixed or disputed if they are caught early.
A general billing service can submit claims, but a freestanding ER needs a partner that also wins underpayments. Look for these four things:
Send us a sample of underpaid facility or physician claims. We will show which ones qualify for mediation, arbitration or federal IDR.
Tell us about your practice and a billing specialist will contact you.
