Match the contract, claim issue and service locality
Texas Department of Insurance resources help practices identify provider payment and contracting issues. Keep a request to improve future rates separate from a dispute over an existing claim. If your schedule is Medicare-based, check the correct service locality and reference year before comparing cities.
- Are you asking for a revised fee schedule, or enforcement of the schedule already in your contract?
What a Texas contract review should establish
Identify executed agreements, later amendments, fee schedules and notice deadlines. Commercial contracts more than five years old are eligible for renegotiation screening; the agreement’s renewal and amendment provisions still govern the process. Higher rates are not guaranteed.
- Which plan products and providers does the agreement cover?
- Which high-volume codes have matched comparison evidence, and which remain unbenchmarked?
- What notice or amendment steps are required before contacting the payer?
National references are not verified local rates
NPAG’s online tools currently use national commercial reference figures for supported codes. They do not show verified state-specific or payer-product-specific offers. A practice-specific comparison must match code, date, locality, network and service setting.
CMS geography is useful when an agreement references Medicare. It is not proof of commercial negotiating leverage. State provider guidance is a starting point for applicable processes, not legal advice or a promise of a new fee schedule.
Official sources and further reading
- Texas Department of Insurance: health care providers
Official provider resources. Confirm whether the plan and claim fall within the department’s authority.
- CMS Physician Fee Schedule locality key
Check the applicable year and service location. Medicare geography does not establish commercial negotiated rates.
NPAG editorial review · October 13, 2026 · Sourcing and corrections