TDI IDR & Federal IDR

In addition to the full revenue cycle management we offer to our clients, Gryphon goes the extra mile. We file, negotiate, and settle disputes between health plans and out-of-network (OON) providers and facilities.  Fully funded accounts are disputed through the State IDR process. Self-funded accounts are disputed through the Federal IDR process.

Our IDR Team works tirelessly and diligently to ensure that our OON clients get their claims reimbursed correctly and at the highest benefit level.

The Federal IDR process is worked through open negotiation forms (ONF) and filed through the CMS portal, as needed, for resolution. The Federal IDR process includes:

• Arbitrations: For billing disputes between OON facilities or health care providers and the health plans.

In Texas, the Texas Department of Insurance (TDI) oversees the IDR process. This process is used to mediate or arbitrate disputes without involving the consumer. Health plans and OON providers or facilities must use the TDI portal to handle these disputes. The State IDR process includes:

• Mediations: For billing disputes between OON facilities and health plans.
• Arbitrations: For billing disputes between OON health care providers (not facilities) and health plans.