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No Surprises Act IDR in Georgia

IDR filing for Georgia providers: which claims go federal, which go state

Georgia is one of the top-four states for federal IDR volume. Its 2020 surprise-billing law covers state-regulated plans and allows self-funded plans to opt in; everything else goes federal.

Federal IDR or the Georgia state process?

Georgia is bifurcated. The Surprise Billing Consumer Protection Act (2020) governs out-of-network emergency and certain non-emergency services under plans regulated by the Georgia Office of the Commissioner of Insurance and Safety Fire. Self-funded ERISA plans may opt in to the Georgia process; those that haven't go to federal IDR. CMS also has a collaborative enforcement arrangement with Georgia for the federal patient-provider dispute process.

The rule of thumb in every bifurcated state: the state law governs plans the state regulates (fully insured employer plans, individual/marketplace plans, and usually HMOs). Self-funded employer plans under ERISA — the majority of commercial coverage — go through federal IDR unless the plan has affirmatively opted into the state process where that's allowed. Getting this wrong is the #1 reason disputes are thrown out as ineligible.

What the numbers look like

  • Georgia was among the four highest-volume states for federal disputes in 2023, alongside Texas, Florida, and Virginia.
  • Emergency medicine and hospital-based specialties across metro Atlanta account for most Georgia disputes.

What we do for Georgia groups

  • Screen plan type and opt-in status claim by claim
  • File federal disputes in batches by payer and code, and run the state process where it applies
  • Price offers on Georgia-specific determination data

Not sure which process applies?

Send 90 days of out-of-network remits and we'll tell you claim by claim: federal IDR, Georgia state process, or not disputable — plus what similar disputes have paid.

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Related

How the federal IDR process works
IDR data & benchmarks
Other states

Find out what your out-of-network claims are actually worth.

Send us a sample of recent OON remits. We'll tell you which claims are IDR-eligible, what similar disputes have paid, and what we'd file. No fee unless we win you more.

Request a free eligibility review