How to read the Arizona IDR market
Arizona is one of the largest federal IDR markets in the CMS public files. For a provider group, the useful comparison is rarely the national average. The better question is how a payer behaves in the same state, service mix, and specialty lane.
The tables below show the payer, code, and IDR entity mix that shape Arizona disputes. Use them to spot where an underpaid out-of-network book may deserve a closer NSA workflow review.
Top payers in Arizona federal IDR disputes
| Payer | Disputes | Provider win rate |
|---|---|---|
| UnitedHealthcare | 57,303 | 85.8% |
| BLUE CROSS AND BLUE SHIELD OF ARIZONA | 43,720 | 81.3% |
| Aetna | 21,886 | 91.4% |
| Cigna (cigna.com) | 16,654 | 82.9% |
| UMR | 9,893 | 86% |
| AMBETTER | 1,838 | 95.2% |
| Cigna (zelis.com) | 1,659 | 88% |
| UMR (clearhealthcloud.com) | 1,431 | 83.1% |
Top service codes in Arizona
| Code | Service | Disputes | Provider win rate |
|---|---|---|---|
| 99284 | Emergency department visit for the evaluation and management of a patient, which... | 24,074 | 85.7% |
| 99285 | Emergency department visit, high severity, requiring urgent evaluation | 17,773 | 84.2% |
| 99283 | Emergency department visit for the evaluation and management of a patient.... | 10,791 | 80.1% |
| 00812 | Anesthesia for screening colonoscopy | 9,337 | 81.2% |
| 74177 | CT scan of the abdomen and pelvis with IV contrast | 9,131 | 89.1% |
| 71045 | Chest X-ray, single view | 7,350 | 90.2% |
| 80053 | Comprehensive metabolic panel (14 blood chemistry tests) | 7,019 | 78.8% |
| 70450 | CT scan of the head/brain without contrast | 6,685 | 90% |
Certified IDR entity mix
| Certified IDR entity | Disputes | Provider win rate | Median award |
|---|---|---|---|
| Federal Hearings and Appeals Services, Inc. | 11,058 | 77.9% | 7.1x |
| Provider Resources, Inc. | 10,617 | 93.2% | 18.2x |
| C2C Innovative Solutions, Inc. | 9,796 | 78.5% | 10.2x |
| Maximus Federal Services, Inc. | 9,244 | 89.8% | 22.1x |
| Island Peer Review Organization | 7,823 | 99.2% | 9.4x |
| EdiPhy Advisors, L.L.C. | 6,199 | 92.8% | 8.4x |
| MCMC Services, LLC | 3,560 | 89.3% | 5.8x |
Open the live Arizona dashboard
Use the data explorer to filter Arizona by specialty, payer, and year, then compare the results with your own disputed claims.
FAQ
How many federal IDR disputes are in Arizona?
The Arizona page currently shows 160,271 CMS disputes in the benchmark dataset.
What is the provider win rate in Arizona?
The non-default provider win rate in Arizona is 84.8% in this dataset.
Why can Arizona differ from national IDR averages?
State, payer, service-code mix, and routing rules can change the economics of a dispute. That is why state-specific benchmarks are more useful than a single national win rate.
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.