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No Surprises Act IDR in New York

IDR filing for New York providers: which claims go federal, which go state

New York had a surprise-billing IDR system years before the federal one. Insured plans go through the New York State process; self-funded employer plans go to federal IDR.

Federal IDR or the New York state process?

New York is bifurcated. The state's Emergency Medical Services and Surprise Bills law (Financial Services Law Article 6, 2015) governs out-of-network emergency and surprise bills under plans regulated by the Department of Financial Services — fully insured employer coverage, individual and marketplace plans, and HMOs. Self-funded ERISA plans go to the federal IDR 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

  • New York was among the top seven states for federal disputes in 2024 (with Texas, Florida, Arizona, New Jersey, and Tennessee).
  • In the New York state process, providers prevail in roughly 81% of decisions — close to the federal rate.
  • The state process uses baseball-style arbitration too, so offer strategy carries over between the two.

What we do for New York groups

  • Route each claim to DFS or the federal portal based on plan type
  • Run both processes with the correct notices and deadlines
  • Build offers from New York-specific award data and downstate market evidence

Not sure which process applies?

Send 90 days of out-of-network remits and we'll tell you claim by claim: federal IDR, New York 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