Texas medical-billing arbitration and mediation support.

Pathway overview

Start with the governing plan and claim facts.

Texas uses independent dispute resolution for qualifying out-of-network medical-billing disputes under state-regulated coverage and participating plans. The state process uses arbitration for certain provider disputes and mediation for certain facility disputes.

Important distinctions

What provider teams should identify early.

• Arbitration is used for qualifying disputes between out-of-network healthcare providers and health plans.
• Mediation is used for qualifying disputes between out-of-network facilities and health plans.
• Federal law generally governs plans outside TDI regulation and air-ambulance services, subject to claim-specific review.

PRP operating scope

One managed workflow from review through outcome.

1. 01

   Review the plan, service, payment or denial, notices, and procedural timing.

2. 02

   Confirm the likely federal or state pathway before initiating work.

3. 03

   Manage negotiation notices, filing steps, deadlines, and communications.

4. 04

   Organize client-supplied records into a clear supporting submission.

5. 05

   Track status, outcomes, and incremental recovery in the client dashboard.