Whether a claim goes to federal IDR or a state process depends on the state and the plan type. These are the highest-volume states; pick yours.
#1 in disputes nationally · TDI process for insured plans, federal for self-funded
#2 nationally · state program for insured/HMO above thresholds, federal otherwise
DFS process for insured plans (81% provider win rate), 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
We file nationally. Send remits and we'll tell you which process applies.
Twenty-two states are "bifurcated" (some claims federal, some state). In the other 28 states and DC, all qualifying claims go through federal IDR. Air ambulance disputes go federal everywhere.
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.
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