Federal IDR in Georgia
Georgia 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 Georgia.
2025 Q1–Q4 · State = Location of Service
Claim lines
169,465
Across 71,620 disputes
Decided lines
160,452
No-decision lines excluded
Provider win rate
86.0%
Defaults count as losses
Median prevailing offer
298%
Of QPA, uncapped median
323% of QPA median provider offer.
3.9% default-loss share of lines.
41 days median time to determination.
Applicability
Does Georgia law or federal IDR apply?
Georgia's Surprise Billing Consumer Protection Act establishes state protections and an arbitration process for claims involving healthcare plans and state healthcare plans defined under Georgia insurance law. The state process applies where Georgia law governs the plan and claim.
Federal protections and federal IDR can apply to eligible claims involving self-funded employer plans and other federally regulated coverage outside Georgia's insurance jurisdiction. The correct path depends on plan type, service, facility, provider, and claim facts.
Georgia 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 | 32,441 | 31,033 | 87.1% |
| 2025 Q2 | 46,305 | 42,770 | 84.6% |
| 2025 Q3 | 49,692 | 47,645 | 86.4% |
| 2025 Q4 | 41,027 | 39,004 | 86.2% |
Payers with the most Georgia claim lines
| Payer | Lines | Provider win rate | Median prevailing / QPA | Default-loss share |
|---|---|---|---|---|
| Anthem | 55,121 | 86.5% | 341% | 4.7% |
| UnitedHealthcare | 30,792 | 88.6% | 189% | 1.6% |
| Cigna | 23,856 | 82.3% | 327% | 3.6% |
| Centene | 20,677 | 87.2% | 280% | 6.2% |
| MultiPlan | 20,395 | 80.4% | 319% | 4.7% |
| ClearHealth Strategies | 4,578 | 86.8% | 151% | 2.5% |
| Aetna | 3,246 | 90.0% | 335% | 1.0% |
| BCBS Texas | 2,221 | 92.9% | 2741% | 1.0% |
Certified IDR entities in the Georgia 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. | 23,908 | 88.1% |
| MCMC Services, LLC | 7,877 | 93.7% |
| iMPROve Health | 7,270 | 90.4% |
| National Medical Reviews, Inc. | 6,654 | 82.0% |
| Maximus Federal Services, Inc. | 6,428 | 91.5% |
| Network Medical Review Company, Ltd. | 6,155 | 75.2% |
| EdiPhy Advisors, L.L.C. | 6,106 | 96.2% |
| Provider Resources, Inc. | 5,869 | 95.1% |
Specialty mix
The supplied analysis groups usable specialty labels into provider categories. The unknown bucket is omitted.
| Specialty | Lines | Provider win rate |
|---|---|---|
| Emergency | 110,666 | 88.3% |
| Hospital medicine | 17,934 | 94.5% |
| Neuromonitoring | 11,918 | 87.0% |
| Radiology | 7,376 | 78.9% |
| Other | 4,632 | 57.1% |
| Anesthesia | 4,424 | 71.1% |
What the Georgia data shows
Emergency services account for most of the supplied Georgia specialty lines, and Anthem is the largest listed payer. Hospital medicine has a different provider win rate from radiology, anesthesia, and the grouped other category, underscoring how much case mix sits inside the statewide result.
Payer default-loss shares and uncapped prevailing-offer medians also vary across the table. The named Q3 and Q4 certified IDR entity results describe another layer of mix, not a controlled ranking of entity performance.
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 Georgia 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.