What the Florida Blue data says
The Florida Blue page is built for provider and RCM teams comparing out-of-network payment behavior under the No Surprises Act. A payer average can hide large swings by state and service code, so the tables focus on the combinations most likely to affect a claim file.
Use this page as a screen: if your disputed claims share the same payer, state, and code mix, the benchmark can tell you whether a deeper audit is worth time.
Top Florida Blue service codes
| Code | Service | Disputes | Provider win rate | Median award |
|---|---|---|---|---|
| 99284 | Emergency department visit for the evaluation and management of a patient, which... | 10,061 | 86.6% | 3.1x |
| 99285 | Emergency department visit, high severity, requiring urgent evaluation | 9,928 | 87% | 2.8x |
| 95941 | Continuous intraoperative neurophysiology monitoring, from outside the operating... | 3,674 | 92.7% | 13.1x |
| 95938 | Short-latency somatosensory evoked potential study, stimulation of any/all... | 3,622 | 92.3% | 37.5x |
| 95939 | Central motor evoked potential study (transcranial motor stimulation); in upper... | 2,527 | 93.2% | 17.6x |
| 99291 | Critical care, first 30-74 minutes | 1,309 | 89.3% | 2.5x |
| 99283 | Emergency department visit for the evaluation and management of a patient.... | 707 | 89.1% | 3.5x |
| 95870 | Needle electromyography; limited study of muscles in 1 extremity or non-limb... | 445 | 97.6% | 9.8x |
Top states for Florida Blue disputes
| State | Disputes |
|---|---|
| Florida | 29,991 |
| Pennsylvania | 1,257 |
| Delaware | 437 |
| Virginia | 341 |
| Alabama | 314 |
| Minnesota | 210 |
| South Carolina | 150 |
| Rhode Island | 138 |
Frequent filing representatives
| Representative domain | Disputes | Provider win rate |
|---|---|---|
| agshealth.com | 9,466 | 98.6% |
| scp-health.com | 9,441 | 98.3% |
| specialtycare.net | 8,385 | 92.4% |
| halomd.com | 2,394 | 89.1% |
| radixhealth.io | 737 | 92.3% |
| callagyrecovery.com | 535 | 93.7% |
| natera.com | 482 | 91.1% |
Benchmark your Florida Blue claims
If Florida Blue is a meaningful payer in your out-of-network book, compare your payment and denial patterns against the CMS benchmark before expanding IDR operations.
FAQ
How many Florida Blue federal IDR disputes are in the dataset?
This benchmark shows 34,039 Florida Blue disputes tied to bcbsfl.com.
What is the provider win rate against Florida Blue?
The non-default provider win rate is 91.3% in this payer slice.
Why does Florida Blue need state and code filtering?
Federal IDR outcomes vary by state, service line, and code mix. A payer-level average is a starting point, not the full answer.
Related benchmarks
Sources and method
- CMS: Federal IDR reports and public use files
- CMS: About Independent Dispute Resolution
- CMS: Federal IDR timeline for claims
Data source: CMS Federal IDR public use files, coverage through 2025Q4; data build 2026-09-21. Counts are CMS dispute counts unless a table says line items. Win rates labeled non-default exclude payer no-show defaults. Award multiples are medians versus QPA. Dollar figures, where shown, are anchored estimates from CMS QPA-and-offer fields, not payment records. This page is informational, not legal or reimbursement advice.