Whether a claim goes to federal IDR or a state process depends on the state and the plan type. Twenty-two states have their own protections; in nearly all of them, self-funded plans still go federal.
#1 in disputes nationally · TDI process for insured plans, federal for self-funded
#2 nationally · state program above thresholds, federal otherwise
DFS arbitration for insured plans, federal for self-funded
State law + self-funded opt-in · federal for non-opted-in plans
Top-4 federal volume · state law with self-funded opt-in
AB 72 payment standard and DMHC process · federal for self-funded
Binding state arbitration for insured plans · federal for self-funded
Payment standard plus arbitration above a threshold · federal for self-funded
Commercially reasonable standard, arbitration, self-funded opt-in
Payment formula · arbitration limited to documented complexity
Formula-based payment standard · federal for self-funded
No comprehensive state law — essentially everything goes federal
Limited state protections · federal IDR is the path
No state program · federal IDR for all covered claims
Narrow patient-initiated state process · provider disputes go federal
We file nationally. Send remits and we'll tell you which process applies.
Twenty-two states have surprise-billing protections, and in 21 of them the state law covers only part of the field — the federal process applies to the rest. Self-funded ERISA plans generally go federal everywhere, and air ambulance disputes are federal in every state. We confirm plan type and routing on every claim before filing.
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