The Texas Department of Insurance administers Independent Dispute Resolution (IDR), a mediation and arbitration process for certain health care billing disputes between out-of-network providers and health plans. Mediation is used for billing disputes between out-of-network facilities and health plans. Arbitration is used for billing disputes between out-of-network health care providers (not facilities) and health plans. Medical services or supplies received on or after January 1, 2020 may be eligible for IDR. To learn more, go to the TDI webpage, Mediation and arbitration of medical bills.

The Texas Department of Insurance is responsible for monitoring the continuing education (CE) compliance of people licensed to sell insurance or adjust property claims. This data set includes a row for each CE course completed by a licensee.

This dataset includes information related to network adequacy waiver requests filed by major medical health benefit plans. It includes data on physicians, providers, and facilities, other than facility-based physicians and providers. Related datasets are available for major medical (facility-based providers) and vision plans:

• Facility-based Physicians & Providers: Network Adequacy Waiver Request - Facility based Physicians & Providers.This dataset relates to waiver requests for networks used for major medical PPO and EPO plans and includes data on facility-based physicians and providers.

• Vision: Network Adequacy Waiver Request - Vision. This dataset relates to waiver requests for networks used for vision PPO and EPO plans.

Insurers offering health benefits through a preferred or exclusive provider benefit plan (also called PPO and EPO plans) are required to demonstrate that the health insurance network meets Texas network adequacy standards. When a network does not meet these requirements and has a deficiency in a county for a specific physician or provider specialty type, an insurer may apply for a waiver to continue operating within its service area. The commissioner of the Texas Department of Insurance (TDI) may grant the waiver following a public hearing and consideration of relevant testimony and information.

Anyone may attend the public hearing and offer testimony. Learn more about how to submit information related to a waiver request or participate in a hearing here: Network Adequacy Standards Waivers.

The Texas Department of Insurance, Division of Workers' Compensation (DWC) maintains a database of professional medical billing services (SV1). It contains charges, payments, and treatments billed on a CMS-1500 form by doctors and other health care professionals who treat injured employees, including ambulatory surgical centers, with dates of service more than five years old going back to 2010. For datasets from the past five years, see professional medical billing services (SV1) detail information.

The detail contains information to identify insurance carriers, injured employees, employers, place of service, and diagnostic information. The bill details are individual line items that are grouped in the header section of a single bill. The bill selection date and bill ID must be used to group individual line items into a single bill. Find more information in our professional medical billing services (SV1) detail data dictionary.

See professional medical billing services (SV1) header information – historical for the corresponding header records related to this dataset.

Go to our page on DWC medical state reporting public use data file (PUDF) to learn more about using this information.

This dataset includes information related to network adequacy waiver requests filed by major medical health benefit plans. It includes data on facility-based physicians and providers. Related datasets are available for major medical (non-facility-based providers) and vision plans:

• Major medical: Network Adequacy Waiver Request - Major Medical. This dataset relates to waiver requests for networks used for major medical PPO and EPO plans and includes data on physicians, providers, and facilities, other than facility-based physicians and providers.

• Vision: Network Adequacy Waiver Request - Vision. This dataset relates to waiver requests for networks used for vision PPO and EPO plans.

Insurers offering health benefits through a preferred or exclusive provider benefit plan (also called PPO and EPO plans) are required to demonstrate that the health insurance network meets Texas network adequacy standards. When a network does not meet these requirements and has a deficiency in a county for a specific physician or provider specialty type, an insurer may apply for a waiver to continue operating within its service area. The commissioner of the Texas Department of Insurance (TDI) may grant the waiver following a public hearing and consideration of relevant testimony and information.

Anyone may attend the public hearing and offer testimony. Learn more about how to submit information related to a waiver request or participate in a hearing here: Network Adequacy Standards Waivers.

The Texas Department of Insurance, Division of Workers’ Compensation (DWC) maintains a database of pharmacy medical billing services (SV4). It contains charges, payments, and prescriptions billed on a DWC Form-066, Statement of Pharmacy Services by pharmacies with dates of service more than five years old going back to 2010. For datasets from the past five years, see pharmacy medical billing services (SV4) header information.

The header identifies insurance carriers, injured employees, employers, place of service, and diagnostic information. The bill header information groups individual line items reported in the detail section. The bill selection date and bill ID must be used to group individual line items into a single bill. Find more information in our pharmacy medical billing services (SV4) header data dictionary.

See pharmacy medical billing services (SV4) detail information – historical for the corresponding detail records related to this dataset.

Go to our page on DWC medical state reporting public use data file (PUDF) to learn more about using this information.

The Texas Department of Insurance (TDI) regulates the state’s insurance industry and oversees the administration of the Texas workers’ compensation system. This data set includes counts for confirmed complaints and policies in force by company name and line of coverage. The complaint index is calculated by dividing the company's percentage of complaints for a specific line of insurance by the company's percentage of policies in force for the same line of insurance. The average index is 1.00. A number less than 1 indicates fewer complaints than average. A number greater than 1 indicates more complaints than average. Please visit TDI Complaints: All Data for details about processed complaints.

The Texas Department of Insurance, Division of Workers' Compensation (DWC) maintains a database of professional medical billing services (SV1). It contains charges, payments, and treatments billed on a CMS-1500 form by doctors and other health care professionals who treat injured employees, including ambulatory surgical centers, with dates of service more than five years old going back to 2010. For datasets from the past five years, see professional medical billing services (SV1) header information.

The header identifies insurance carriers, injured employees, employers, place of service, and diagnostic information. The bill header information groups individual line items reported in the detail section. The bill selection date and bill ID must be used to group individual line items into a single bill. Find more information in our professional medical billing services (SV1) header data dictionary.

See professional medical billing services (SV1) detail information – historical for the corresponding detail records related to this dataset.

Go to our page on DWC medical state reporting public use data file (PUDF) to learn more about using this information.

This dataset includes information related to network adequacy waiver requests filed by vision plans. Related datasets are available for major medical PPO and EPO plans:

Major medical
•Network Adequacy Waiver Request - Facility based Physicians & Providers. This dataset relates to waiver requests for networks used for major medical PPO and EPO plans and includes data on facility-based physicians and providers.
• Network Adequacy Waiver Request - Major Medical. This dataset relates to waiver requests for networks used for major medical PPO and EPO plans and includes data on physicians, providers, and facilities, other than facility-based physicians and providers.

Insurers offering vision benefits through a preferred or exclusive provider benefit plan (also called PPO and EPO plans) are required to demonstrate that the health insurance network meets Texas network adequacy standards. When a network does not meet these requirements and has a deficiency in a county for a specific physician or provider specialty type, an insurer may apply for a waiver to continue operating within its service area. The commissioner of the Texas Department of Insurance (TDI) may grant the waiver following a public hearing and consideration of relevant testimony and information.

Anyone may attend the public hearing and offer testimony. Learn more about how to submit information related to a waiver request or participate in a hearing here: Network Adequacy Standards Waivers.

The Texas Department of Insurance, Division of Workers’ Compensation (DWC) maintains a database of institutional medical billing services (SV2). It contains charges, payments, and treatments billed on a CMS-1450 form (UB-92, UB-04) by hospitals and medical facilities that treat injured employees, excluding ambulatory surgical centers, with dates of service more than five years going back to 2010. For datasets from the past five years, see institutional medical billing services (SV2) detail information.

The detail contains information to identify insurance carriers, injured employees, employers, place of service, and diagnostic information. The bill details are individual line items that are grouped in the header section of a single bill. The bill selection date and bill ID must be used to group individual line items into a single bill. Find more information in our institutional medical billing services (SV2) detail data dictionary.

See institutional medical billing services (SV2) header information – historical for the corresponding header records related to this dataset.

Go to our page on DWC medical state reporting public use data file (PUDF) to learn more about using this information.