Federal IDR payer outcomes
Blue Cross Blue Shield of Texas federal IDR outcomes
See 2025 CMS federal IDR volume, provider offer selection, leave-one-out comparisons, offer levels, defaults, states, specialties, and certified IDR entity mix for responses from bcbstx.com.
2025 Q1–Q4 · Response domain: bcbstx.com · Closing-quarter basis
How did providers fare against Blue Cross Blue Shield of Texas in federal IDR?
In 2025, providers had their offer selected on 87.9% of 1,148,437 decided claim lines answered from bcbstx.com, across 373,648 disputes. Defaults count as losses in that rate and are reported separately below.
Claim lines
1,197,912
Across 373,648 disputes
Decided lines
1,148,437
No-decision lines excluded
Provider win rate
87.9%
Defaults count as losses
Median prevailing offer
606%
Of QPA, uncapped median
714% of QPA median provider offer.
100% of QPA median payer offer.
1.6% default-loss share.
27 days median determination.
Compared with all other payer domains
| Population | Provider win rate | Median prevailing / QPA | Default-loss share |
|---|---|---|---|
| Blue Cross Blue Shield of Texas | 87.9% | 606% | 1.6% |
| All other payer domains | 86.0% | 370% | 2.6% |
Payer identity
What bcbstx.com represents
This page groups disputes by the email domain of the responding party recorded by CMS. The report-card pipeline uses response domain because plan names are free text with hundreds of spelling variants.
Plan names as entered by parties
| Plan name | Lines |
|---|---|
| BCBSTX | 362,110 |
| BLUE CROSS AND BLUE SHIELD OF TEXAS | 191,972 |
| BLUECROSS BLUESHIELD OF TEXAS | 122,591 |
| BCBS OF TEXAS | 116,149 |
| BCBS of Texas | 74,700 |
Plan type mix
| Plan type | Lines |
|---|---|
| Either partially or fully self-insured private (employment-based) group health plan | 765,560 |
| Individual health insurance issuer | 189,836 |
| Fully insured private group health plan | 147,426 |
| No Plan/Issuer Response | 47,957 |
Blue Cross Blue Shield of Texas outcomes by closing quarter
The quarter is the quarter in which a dispute closed. These figures are descriptive snapshots. They do not establish a directional pattern because CMS publishes in arrears and can restate records.
| Closing quarter | Lines | Decided lines | Provider win rate |
|---|---|---|---|
| 2025 Q1 | 158,965 | 158,386 | 87.1% |
| 2025 Q2 | 280,720 | 271,670 | 91.0% |
| 2025 Q3 | 395,637 | 378,602 | 91.9% |
| 2025 Q4 | 362,590 | 339,779 | 81.4% |
Where Blue Cross Blue Shield of Texas disputes occurred
State is the CMS Location of Service field. Prevailing-offer figures are uncapped medians and are printed as computed, including unusually high values.
Specialty mix
Usable specialty labels are grouped into provider categories. The unknown bucket is omitted.
| Specialty | Lines | Provider win rate |
|---|---|---|
| Emergency | 947,445 | 88.6% |
| Neuromonitoring | 65,447 | 92.4% |
| Hospital medicine | 57,402 | 90.1% |
| Radiology | 21,768 | 77.2% |
| Surgery | 17,954 | 93.5% |
| Anesthesia | 17,722 | 96.1% |
Certified IDR entity mix
CMS added the named certified IDR entity field beginning with the 2025 Q3 file. This table covers named Q3 and Q4 records only and should not be compared with the full-year payer totals.
| Certified IDR entity | Lines | Provider win rate |
|---|---|---|
| Federal Hearings and Appeals Services, Inc. | 387,324 | 78.7% |
| C2C Innovative Solutions, Inc. | 139,733 | 93.9% |
| Island Peer Review Organization | 97,281 | 98.3% |
| EdiPhy Advisors, L.L.C. | 40,686 | 96.3% |
| MCMC Services, LLC | 32,768 | 92.2% |
| Provider Resources, Inc. | 27,846 | 98.3% |
Methodology, sources, and limits
This page uses all four 2025 CMS Federal IDR Public Use Files for out-of-network emergency and non-emergency items and services. Air ambulance is excluded. Lines are deduplicated to the latest quarterly record.
A payer is the email domain of the responding party recorded by CMS. This page includes responses from bcbstx.com. Recourse uses response domain because plan names are free text with hundreds of spelling variants.
Win rate is the share of decided lines where the provider offer was selected. Lines with no decision are excluded from both numerator and denominator. Default decisions count as losses and are also shown separately. Disputes are dated by closing quarter.
Provider, payer, and prevailing-offer figures are uncapped medians as a percentage of QPA. Values are printed as computed, including unusually high medians. Leave-one-out comparisons include all other payer response domains.
Source: CMS Federal IDR Public Use Files, 2025 Q1 through Q4. Full calculation rules: Recourse methodology. Browse all profiles: payer outcomes directory.
What the Blue Cross Blue Shield of Texas pattern means for provider groups
Providers facing the bcbstx.com response domain had an 87.9% offer-selection rate, 1.9 percentage points above the 86.0% rate for all other payer domains. Its median prevailing offer was substantially higher at 606% of QPA versus 370%, and its 1.6% default-loss share was one point lower. Nearly all reported lines were in Texas; the much smaller rows outside Texas include very high uncapped medians and should be read with their line counts, not as equivalent markets.
A provider group's own result can differ because its specialties, services, states, offers, defaults, and filing operations differ from this payer-domain population. The report-card CTA below applies the same measurement framework to the group's own claims.
Your claims involving Blue Cross Blue Shield of Texas
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