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No Surprises Act IDR in Virginia

Virginia: state arbitration, self-funded opt-in, and federal IDR

Virginia's balance billing law uses a commercially reasonable payment rule with arbitration, and lets self-funded plans opt in. Which claims go where, and how we file.

Virginia runs one of the more active state programs

Virginia's balance billing law took effect in 2021. Rather than a rigid fee schedule, it requires plans to pay a commercially reasonable amount based on payments for the same or similar services in the same geographic area. Either party can request negotiation and then arbitration through the Bureau of Insurance if the payment is unsatisfactory.

The self-funded opt-in: Virginia allows self-funded group health plans to elect into the state process. If a plan has opted in, the claim belongs in Virginia's arbitration; if it hasn't, the claim is a federal IDR dispute. Checking opt-in status is a filing step, not a formality.

What we do for Virginia groups

  • Verify plan type and opt-in status for every out-of-network remit
  • File on the correct track and preserve the deadline on the other where facts are ambiguous
  • Build the comparable-rate evidence Virginia arbitrators expect
  • Batch federal disputes by payer and service code

We confirm process and deadlines claim by claim before filing.

Which process applies to your claims?

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

Free claims review

Related

How federal IDR works
IDR eligibility checklist
Deadline calculator
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