Federal IDR in Florida
Florida 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 Florida.
2025 Q1–Q4 · State = Location of Service
Claim lines
383,111
Across 143,284 disputes
Decided lines
378,955
No-decision lines excluded
Provider win rate
88.0%
Defaults count as losses
Median prevailing offer
259%
Of QPA, uncapped median
280% of QPA median provider offer.
3.3% default-loss share of lines.
41 days median time to determination.
Applicability
Does Florida law or federal IDR apply?
Florida law limits balance billing for emergency care and certain nonemergency services under individual and group policies issued by Florida-regulated insurers. State payment rules apply where Florida insurance law governs the plan and claim.
Federal protections and federal IDR can apply to eligible claims involving self-funded employer plans and other coverage outside Florida's insurance jurisdiction. The correct path depends on plan type, service, facility, provider, and claim facts.
Florida 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 | 92,596 | 92,284 | 89.9% |
| 2025 Q2 | 115,748 | 114,155 | 87.6% |
| 2025 Q3 | 90,146 | 88,614 | 88.5% |
| 2025 Q4 | 84,621 | 83,902 | 85.9% |
Payers with the most Florida claim lines
| Payer | Lines | Provider win rate | Median prevailing / QPA | Default-loss share |
|---|---|---|---|---|
| Aetna | 101,214 | 95.5% | 325% | 0.6% |
| UnitedHealthcare | 100,336 | 85.6% | 209% | 1.4% |
| Florida Blue | 69,065 | 96.6% | 305% | 2.0% |
| Cigna | 40,131 | 76.0% | 213% | 10.5% |
| ClearHealth Strategies | 16,411 | 87.4% | 210% | 1.4% |
| Centene | 11,427 | 67.8% | 274% | 28.3% |
| Clear Health (cloud) | 9,494 | 83.5% | 204% | 0.6% |
| MultiPlan | 8,700 | 74.7% | 229% | 7.1% |
Certified IDR entities in the Florida 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. | 42,333 | 90.3% |
| Provider Resources, Inc. | 29,057 | 97.3% |
| MCMC Services, LLC | 18,371 | 92.4% |
| iMPROve Health | 13,483 | 92.5% |
| EdiPhy Advisors, L.L.C. | 12,946 | 97.9% |
| C2C Innovative Solutions, Inc. | 12,597 | 88.7% |
| Island Peer Review Organization | 11,351 | 83.2% |
| Network Medical Review Company, Ltd. | 8,962 | 58.5% |
Specialty mix
The supplied analysis groups usable specialty labels into provider categories. The unknown bucket is omitted.
| Specialty | Lines | Provider win rate |
|---|---|---|
| Emergency | 151,117 | 89.0% |
| Radiology | 92,244 | 98.4% |
| Anesthesia | 80,909 | 82.5% |
| Neuromonitoring | 23,272 | 91.1% |
| Hospital medicine | 12,447 | 88.6% |
| Other | 8,694 | 53.1% |
What the Florida data shows
Aetna, UnitedHealthcare, and Florida Blue account for most of the payer lines shown for Florida, but their provider win rates and prevailing-offer medians are not interchangeable. Cigna and Centene also have materially larger default-loss shares than the statewide figure.
Radiology has the largest provider win rate in the supplied specialty mix, while the grouped other category is substantially lower. The named Q3 and Q4 certified IDR entity table likewise covers a wide range. These figures describe different case mixes and should not be read as 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 Florida 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.