Texas IDR specialists
ZanexMed files and manages Texas Department of Insurance arbitration for physicians and mediation for facilities, including freestanding ERs, and checks every claim against the federal process so it goes down the right route.
ER physicians, anesthesia and other clinicians.
Freestanding ERs and hospitals.
Texas or federal IDR checked per claim.
From the first payment date onward.
Texas IDR is the state dispute process for out of network claims on plans regulated by the Texas Department of Insurance (TDI). It was created by Senate Bill 1264 and applies to services provided on or after January 1, 2020.
It covers out of network emergency care, certain services from out of network providers at in network facilities, and lab or imaging tied to in network care. The patient is kept out of the dispute: the provider and the health plan settle the amount between themselves.
Texas uses two tracks. Arbitration is for physicians and other providers, and the decision is binding. Mediation is for facilities such as freestanding ERs and hospitals. Federal claims follow the No Surprises Act instead. Both Texas tracks are filed through the TDI IDR portal.
Texas deadlines start from the date you receive the first claim payment. A request filed too early or too late is rejected, so we track every date from day one.
| Step | Arbitration (providers) | Mediation (facilities) |
|---|---|---|
| Request window | 20 to 90 days after the first claim payment | 20 to 180 days after the first claim payment |
| Informal settlement | Days 1 to 30 | Days 1 to 30 |
| Neutral assigned | Day 31, if the parties have not agreed on an arbitrator | Day 31, if the parties have not agreed on a mediator |
| Review | Days 31 to 51 | Days 31 to 180 |
| Outcome | Binding decision by day 51 | Mediation conference by day 180, report within 45 days |
Six steps for every Texas claim, with each TDI deadline tracked from the first payment date.
We confirm the plan is state regulated and choose Texas or federal IDR.
We use the internal appeal with the plan first, as TDI asks providers to do.
We file arbitration or mediation inside the correct request window.
We negotiate in the 30 day settlement period, where most cases close.
We build the case around the factors the arbitrator must weigh.
We track the decision or agreement until the payment is posted.
Not every claim qualifies for the Texas process. We check each one before anything is filed.
The plan decides the route. Fully insured plans regulated by TDI, ERS, TRS and self funded plans that opted in use the Texas process. Most other self funded employer plans are regulated under ERISA and use the federal IDR process under the No Surprises Act.
State regulated plans often carry a TDI or DOI mark on the member ID card, but we always confirm with the plan before filing, because the wrong route can end the claim.
Texas arbitrators must weigh ten factors set by TDI. They include 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, the provider training and experience, the complexity of the case, the network contracting history between the parties, and any offer made during the settlement teleconference.
Each arbitrator charges a fixed fee per case, and each side pays half once an arbitrator is assigned. A well documented offer made early is the fastest way to get paid.
782,679
Texas arbitration requests settled in the first 30 days
169,228
Texas arbitration requests decided by an arbitrator
Texas Department of Insurance data, January 2020 to October 7, 2025. Source
Send us your underpaid out of network claims and we will check which ones qualify for Texas or federal IDR, free.
Tell us about your practice and a billing specialist will contact you.
