How to read the Texas IDR market
Texas is one of the largest federal IDR markets in the CMS public files. For a provider group, the useful comparison is rarely the national average. The better question is how a payer behaves in the same state, service mix, and specialty lane.
The tables below show the payer, code, and IDR entity mix that shape Texas disputes. Use them to spot where an underpaid out-of-network book may deserve a closer NSA workflow review.
Top payers in Texas federal IDR disputes
| Payer | Disputes | Provider win rate |
|---|---|---|
| BCBSTX | 354,560 | 84.8% |
| UnitedHealthcare | 157,362 | 81.3% |
| Aetna | 157,348 | 90.9% |
| Cigna / MultiPlan | 101,860 | 81.2% |
| UMR | 37,489 | 81.8% |
| BCBSOK | 18,107 | 78.1% |
| UMR (clearhealthcloud.com) | 12,262 | 85.4% |
| Cigna (cigna.com) | 4,616 | 87% |
Top service codes in Texas
| Code | Service | Disputes | Provider win rate |
|---|---|---|---|
| 99284 | Emergency department visit for the evaluation and management of a patient, which... | 272,903 | 79.9% |
| 99283 | Emergency department visit for the evaluation and management of a patient.... | 123,952 | 76.3% |
| 99285 | Emergency department visit, high severity, requiring urgent evaluation | 99,374 | 82.7% |
| 85025 | Complete blood count (CBC) with automated differential | 55,818 | 81.1% |
| 80053 | Comprehensive metabolic panel (14 blood chemistry tests) | 42,689 | 82.4% |
| 74177 | CT scan of the abdomen and pelvis with IV contrast | 34,110 | 87.4% |
| 81003 | Urinalysis, automated, without microscopy | 32,141 | 78.8% |
| 96375 | IV push injection, each additional drug | 31,056 | 84% |
Certified IDR entity mix
| Certified IDR entity | Disputes | Provider win rate | Median award |
|---|---|---|---|
| Federal Hearings and Appeals Services, Inc. | 169,429 | 75.3% | 7.9x |
| Provider Resources, Inc. | 53,289 | 96.3% | 4.8x |
| C2C Innovative Solutions, Inc. | 42,940 | 89.3% | 4.1x |
| Island Peer Review Organization | 42,777 | 99.3% | 6.0x |
| MCMC Services, LLC | 38,438 | 90.8% | 4.9x |
| EdiPhy Advisors, L.L.C. | 22,505 | 93.5% | 6.5x |
| Maximus Federal Services, Inc. | 19,472 | 92.5% | 9.4x |
Open the live Texas dashboard
Use the data explorer to filter Texas by specialty, payer, and year, then compare the results with your own disputed claims.
FAQ
How many federal IDR disputes are in Texas?
The Texas page currently shows 864,338 CMS disputes in the benchmark dataset.
What is the provider win rate in Texas?
The non-default provider win rate in Texas is 84.4% in this dataset.
Why can Texas differ from national IDR averages?
State, payer, service-code mix, and routing rules can change the economics of a dispute. That is why state-specific benchmarks are more useful than a single national win rate.
Related benchmarks
Sources and method
- CMS: Federal IDR reports and public use files
- CMS: About Independent Dispute Resolution
- CMS: Federal IDR timeline for claims
Data source: CMS Federal IDR public use files, coverage through 2025Q4; data build 2026-09-21. Counts are CMS dispute counts unless a table says line items. Win rates labeled non-default exclude payer no-show defaults. Award multiples are medians versus QPA. Dollar figures, where shown, are anchored estimates from CMS QPA-and-offer fields, not payment records. This page is informational, not legal or reimbursement advice.