Start with routing, not the headline law
Colorado providers have to separate patient-protection rules from the payment-dispute route. A claim can be protected from balance billing and still require a separate decision about whether state law, federal IDR, a plan appeal, or no formal dispute process applies.
For commercial claims, the payer, plan type, service setting, and governing law usually matter before the offer strategy does.
Federal IDR payer mix in Colorado
| Payer | Disputes | Provider win rate |
|---|---|---|
| Anthem Blue Cross | 4,251 | 86.6% |
| Cigna / MultiPlan | 3,663 | 71.3% |
| UnitedHealthcare | 2,936 | 80.3% |
| Aetna | 1,047 | 91% |
| UMR | 782 | 83.4% |
| UMR | 633 | 92.6% |
| BCBSTX | 455 | 90.3% |
| Cigna | 237 | 84% |
Top federal IDR service codes in Colorado
| Code | Service | Disputes | Provider win rate |
|---|---|---|---|
| 95938 | Short-latency somatosensory evoked potential study, stimulation of any/all peripheral... | 2,349 | 82.4% |
| 99284 | Emergency department visit for the evaluation and management of a patient, which... | 2,208 | 83.6% |
| 99285 | Emergency department visit, high severity, requiring urgent evaluation | 1,551 | 76.6% |
| 95861 | Needle electromyography; 2 extremities with or without related paraspinal areas | 1,264 | 84.1% |
| 95939 | Central motor evoked potential study (transcranial motor stimulation); in upper and... | 1,167 | 83.2% |
| 95941 | Continuous intraoperative neurophysiology monitoring, from outside the operating room... | 1,004 | 83.7% |
| G0453 | Continuous intraoperative neurophysiology monitoring (IONM), from outside the operating... | 769 | 77.4% |
| 95937 | Neuromuscular junction testing with repetitive nerve stimulation | 722 | 79.5% |
Provider workflow for Colorado surprise-billing claims
- Confirm the plan type and whether state or federal rules control payment resolution.
- Identify protected emergency, facility-based, ancillary, or air-ambulance services.
- Preserve open-negotiation and federal IDR deadlines when the federal route applies.
- Benchmark any final offer against comparable payer, code, and state outcomes.
Open the Colorado dashboard
Use the live explorer to compare payer and code outcomes before escalating a dispute workflow.
FAQ
Does the No Surprises Act apply in Colorado?
Yes, but claim routing depends on plan type, service setting, payer, and whether state law determines the payment-dispute route.
How many federal IDR disputes are in Colorado?
The current CMS benchmark set includes 14,590 Colorado federal IDR disputes.
What should providers check first in Colorado?
Start with whether the claim is protected, whether state law or federal IDR controls payment resolution, and whether the filing deadline has been preserved.
Related guides
Sources and method
- CMS: Federal IDR reports and public use files
- CMS: About Independent Dispute Resolution
- Colorado Division of Insurance
This page uses CMS Federal IDR public use files through 2025Q4 and is for general information only. State-law routing and reimbursement rules can change; confirm current rules with counsel, the relevant regulator, and your compliance team.