Federal IDR in Oklahoma
Oklahoma 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 Oklahoma.
2025 Q1–Q4 · State = Location of Service
Claim lines
120,928
Across 49,638 disputes
Decided lines
117,971
No-decision lines excluded
Provider win rate
92.7%
Defaults count as losses
Median prevailing offer
523%
Of QPA, uncapped median
579% of QPA median provider offer.
0.9% default-loss share of lines.
32 days median time to determination.
Applicability
Does Oklahoma law or federal IDR apply?
The Oklahoma Insurance Department states that Oklahoma has not enacted separate consumer surprise-billing protections. The federal No Surprises Act therefore supplies the broad protections and payment-dispute framework for covered Oklahoma claims.
Federal IDR applies to eligible disputes involving covered fully insured and self-funded plans. The correct path depends on plan type, service, facility, provider, and claim facts.
Oklahoma 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 | 26,017 | 25,468 | 93.9% |
| 2025 Q2 | 28,796 | 27,775 | 92.4% |
| 2025 Q3 | 36,130 | 35,501 | 93.6% |
| 2025 Q4 | 29,985 | 29,227 | 90.8% |
Payers with the most Oklahoma claim lines
| Payer | Lines | Provider win rate | Median prevailing / QPA | Default-loss share |
|---|---|---|---|---|
| BCBS Illinois | 31,759 | 96.7% | 1151% | 0.9% |
| UnitedHealthcare | 20,346 | 87.6% | 321% | 0.8% |
| BCBS Oklahoma | 19,190 | 97.1% | 1279% | 0.4% |
| Centene | 12,091 | 97.3% | 201% | 0.5% |
| ClearHealth Strategies | 9,660 | 85.3% | 392% | 1.4% |
| MultiPlan | 6,124 | 79.5% | 478% | 1.6% |
| Clear Health (cloud) | 5,572 | 92.5% | 285% | 1.1% |
| BCBS Texas | 3,812 | 94.7% | 9071% | 1.5% |
Certified IDR entities in the Oklahoma 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 |
|---|---|---|
| Island Peer Review Organization | 16,413 | 99.3% |
| C2C Innovative Solutions, Inc. | 16,408 | 94.3% |
| Federal Hearings and Appeals Services, Inc. | 7,053 | 85.4% |
| Provider Resources, Inc. | 4,690 | 92.7% |
| National Medical Reviews, Inc. | 4,564 | 95.1% |
| EdiPhy Advisors, L.L.C. | 4,052 | 95.7% |
| iMPROve Health | 3,721 | 90.5% |
| Maximus Federal Services, Inc. | 3,236 | 92.5% |
Specialty mix
The supplied analysis groups usable specialty labels into provider categories. The unknown bucket is omitted.
| Specialty | Lines | Provider win rate |
|---|---|---|
| Emergency | 90,055 | 93.4% |
| Surgery | 8,588 | 98.0% |
| Hospital medicine | 6,521 | 86.4% |
| Neuromonitoring | 5,779 | 91.3% |
| Anesthesia | 5,186 | 91.0% |
| Pediatrics | 553 | 94.2% |
What the Oklahoma data shows
Emergency services account for most of the supplied Oklahoma specialty lines. BCBS Illinois, UnitedHealthcare, and BCBS Oklahoma are the three largest listed payer populations, and their provider win rates and uncapped prevailing-offer medians differ.
The BCBS Texas payer row has an uncapped median prevailing offer of 9,071% of QPA, exactly as computed in the supplied analysis. It represents a smaller payer population than the leading rows and is reported without rounding or adjustment. The statewide figure remains a blend of different payer, specialty, and entity populations.
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 Oklahoma 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.