Federal IDR in Indiana
Indiana 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 Indiana.
2025 Q1–Q4 · State = Location of Service
Claim lines
135,879
Across 70,413 disputes
Decided lines
135,839
No-decision lines excluded
Provider win rate
87.3%
Defaults count as losses
Median prevailing offer
359%
Of QPA, uncapped median
406% of QPA median provider offer.
1.9% default-loss share of lines.
34 days median time to determination.
Applicability
Does Indiana law or federal IDR apply?
Indiana does not operate a broad specified state payment law that replaces the federal IDR process for the surprise-billing claims covered on this page. Indiana consumers and plans receive the federal protections established by the No Surprises Act.
Federal IDR applies to eligible payment disputes under covered plans. The correct path still depends on plan type, service, facility, provider, and claim facts, and limited state requirements may apply in other contexts.
Indiana 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 | 28,718 | 28,714 | 86.5% |
| 2025 Q2 | 42,101 | 42,089 | 89.4% |
| 2025 Q3 | 36,083 | 36,078 | 85.6% |
| 2025 Q4 | 28,977 | 28,958 | 87.3% |
Payers with the most Indiana claim lines
| Payer | Lines | Provider win rate | Median prevailing / QPA | Default-loss share |
|---|---|---|---|---|
| UnitedHealthcare | 42,339 | 86.1% | 407% | 1.8% |
| Anthem | 35,284 | 85.2% | 272% | 0.9% |
| Aetna | 17,086 | 93.2% | 484% | 0.6% |
| ClearHealth Strategies | 16,967 | 91.7% | 405% | 2.6% |
| MultiPlan | 9,208 | 82.2% | 359% | 2.0% |
| Clear Health (cloud) | 5,101 | 88.6% | 332% | 0.9% |
| CareSource | 2,146 | 91.1% | 320% | 0.8% |
| BCBS Texas | 1,838 | 87.9% | 1675% | 4.2% |
Certified IDR entities in the Indiana 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. | 11,123 | 90.1% |
| Provider Resources, Inc. | 9,269 | 92.4% |
| C2C Innovative Solutions, Inc. | 6,273 | 84.9% |
| Island Peer Review Organization | 5,998 | 93.7% |
| iMPROve Health | 5,187 | 90.1% |
| EdiPhy Advisors, L.L.C. | 4,953 | 98.7% |
| Network Medical Review Company, Ltd. | 3,717 | 66.3% |
| MCMC Services, LLC | 3,694 | 94.7% |
Specialty mix
The supplied analysis groups usable specialty labels into provider categories. The unknown bucket is omitted.
| Specialty | Lines | Provider win rate |
|---|---|---|
| Emergency | 68,780 | 86.5% |
| Radiology | 53,392 | 90.7% |
| Anesthesia | 5,000 | 78.1% |
| Neuromonitoring | 3,889 | 86.3% |
| Hospital medicine | 2,025 | 85.8% |
| Pediatrics | 1,316 | 88.2% |
What the Indiana data shows
Emergency services and radiology account for most of the supplied Indiana specialty lines. UnitedHealthcare and Anthem are the largest listed payer populations, followed by Aetna and ClearHealth Strategies.
Provider win rates, default-loss shares, and uncapped prevailing-offer medians vary across those payer rows. The named Q3 and Q4 certified IDR entity results add another mix dimension, so the statewide figure should not be read as one uniform provider experience.
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 Indiana 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.