Federal IDR in Arizona
Arizona surprise billing law and federal IDR
See which dispute path may apply, then examine 2025 federal IDR volume, provider offer selection, payer outcomes, certified IDR entity mix, and specialties for services delivered in Arizona.
2025 Q1–Q4 · State = Location of Service
Claim lines
440,016
Across 160,511 disputes
Decided lines
425,283
No-decision lines excluded
Provider win rate
83.4%
Defaults count as losses
Median prevailing offer
480%
Of QPA, uncapped median
604% of QPA median provider offer.
2.4% default-loss share of lines.
38 days median time to determination.
Applicability
Does Arizona law or federal IDR apply?
Arizona operates the Surprise Out-of-Network Billing Dispute Resolution program for qualifying bills under state insurance law. The state process generally applies to coverage regulated by Arizona and does not apply to self-funded ERISA plans.
Federal protections and federal IDR can apply when Arizona law does not govern the plan or claim. The correct path depends on plan type, service, facility, provider, and claim facts.
Arizona outcomes by closing quarter
The quarter is the quarter in which a dispute closed. These figures are descriptive snapshots. They do not establish a directional pattern because CMS publishes in arrears and can restate records.
| Closing quarter | Lines | Decided lines | Provider win rate |
|---|---|---|---|
| 2025 Q1 | 106,434 | 103,968 | 84.9% |
| 2025 Q2 | 143,849 | 140,215 | 83.5% |
| 2025 Q3 | 102,253 | 98,629 | 83.2% |
| 2025 Q4 | 87,480 | 82,471 | 81.7% |
Payers with the most Arizona claim lines
| Payer | Lines | Provider win rate | Median prevailing / QPA | Default-loss share |
|---|---|---|---|---|
| Blue Cross Blue Shield of Arizona | 146,423 | 78.0% | 560% | 3.8% |
| UnitedHealthcare | 144,559 | 85.2% | 636% | 1.4% |
| Cigna | 50,982 | 85.7% | 285% | 1.6% |
| Aetna | 45,518 | 88.1% | 333% | 3.2% |
| ClearHealth Strategies | 28,355 | 88.5% | 465% | 0.7% |
| Zelis | 4,838 | 96.6% | 282% | 0.4% |
| Clear Health (cloud) | 3,756 | 80.8% | 374% | 1.4% |
| MultiPlan | 3,394 | 81.0% | 374% | 1.7% |
Certified IDR entities in the Arizona data
CMS added the named certified IDR entity field beginning with the 2025 Q3 file. This table therefore covers named Q3 and Q4 records only and should not be compared with the full-year state totals.
| Certified IDR entity | Lines | Provider win rate |
|---|---|---|
| Federal Hearings and Appeals Services, Inc. | 47,833 | 80.7% |
| C2C Innovative Solutions, Inc. | 20,346 | 78.4% |
| Island Peer Review Organization | 20,120 | 93.5% |
| Provider Resources, Inc. | 18,708 | 93.1% |
| Maximus Federal Services, Inc. | 16,103 | 90.1% |
| EdiPhy Advisors, L.L.C. | 12,297 | 91.8% |
| MCMC Services, LLC | 10,813 | 85.3% |
| Network Medical Review Company, Ltd. | 10,712 | 74.0% |
Specialty mix
The supplied analysis groups usable specialty labels into provider categories. The unknown bucket is omitted.
| Specialty | Lines | Provider win rate |
|---|---|---|
| Emergency | 177,421 | 82.6% |
| Radiology | 119,711 | 92.5% |
| Anesthesia | 58,298 | 80.7% |
| Hospital medicine | 52,006 | 76.8% |
| Neuromonitoring | 7,723 | 84.3% |
| Surgery | 3,067 | 85.0% |
What the Arizona data shows
Arizona's statewide totals combine two similarly sized payer populations: Blue Cross Blue Shield of Arizona and UnitedHealthcare together account for most of the listed claim lines. Their provider win rates and prevailing-offer medians differ, so the statewide result should not be treated as one uniform payer experience.
Radiology carries a 92.5% provider win rate in the supplied specialty mix, while hospital medicine and anesthesia are lower. Named Q3 and Q4 certified IDR entity results also span a broad range. These are descriptive aggregates, not controlled comparisons.
A provider group's own result can differ because its payer mix, specialty, services, offers, defaults, and filing operations differ from the statewide population. The report-card CTA below applies the same measurement framework to the group's own claims.
Methodology, sources, and limits
This page uses all four 2025 CMS Federal IDR PUF files for OON emergency and non-emergency items and services. Air ambulance is excluded. Lines are deduplicated to the latest quarterly record. State is the Location of Service field.
Win rate is the share of decided lines where the provider offer was selected. Lines with no decision are excluded from both numerator and denominator. Default decisions count as losses and are also shown separately. Disputes are dated by closing quarter.
Provider-offer and prevailing-offer figures are uncapped medians of the respective offer as a percentage of QPA. Values are printed as computed, including unusually high medians. They are not rounded away or adjusted.
Source: CMS Federal IDR Public Use Files, 2025 Q1 through Q4. Q1 and Q2 data as of January 21, 2026; Q3 and Q4 published July 15, 2026. Full calculation rules: Recourse methodology.
Your Arizona claims
See how your group's IDR outcomes compare.
Request a free per-group report card using the same 2025 CMS methodology shown on this page.