How to read the Georgia IDR market
Georgia 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 Georgia disputes. Use them to spot where an underpaid out-of-network book may deserve a closer NSA workflow review.
Top payers in Georgia federal IDR disputes
| Payer | Disputes | Provider win rate |
|---|---|---|
| Anthem Blue Cross | 33,590 | 88.9% |
| UnitedHealthcare | 18,591 | 91.3% |
| Cigna / MultiPlan | 6,554 | 82.3% |
| Cigna (cigna.com) | 4,156 | 80.2% |
| UMR | 1,815 | 87.4% |
| Aetna | 1,426 | 89.4% |
| AMBETTER | 1,414 | 87.9% |
| BCBSTX | 1,051 | 90.8% |
Top service codes in Georgia
| Code | Service | Disputes | Provider win rate |
|---|---|---|---|
| 99284 | Emergency department visit for the evaluation and management of a patient, which... | 30,132 | 88.9% |
| 99285 | Emergency department visit, high severity, requiring urgent evaluation | 21,107 | 89.8% |
| 99283 | Emergency department visit for the evaluation and management of a patient.... | 4,138 | 88.2% |
| 99291 | Critical care, first 30-74 minutes | 3,694 | 90.9% |
| 95938 | Short-latency somatosensory evoked potential study, stimulation of any/all... | 2,692 | 84% |
| 95941 | Continuous intraoperative neurophysiology monitoring, from outside the operating... | 1,778 | 83.3% |
| 95939 | Central motor evoked potential study (transcranial motor stimulation); in upper... | 1,412 | 84.7% |
| 95870 | Needle electromyography; limited study of muscles in 1 extremity or non-limb... | 1,049 | 85.4% |
Certified IDR entity mix
| Certified IDR entity | Disputes | Provider win rate | Median award |
|---|---|---|---|
| Federal Hearings and Appeals Services, Inc. | 4,772 | 90% | 3.4x |
| iMPROve Health | 4,540 | 91.2% | 3.2x |
| Provider Resources, Inc. | 3,792 | 95.3% | 3.2x |
| C2C Innovative Solutions, Inc. | 2,945 | 95.5% | 3.2x |
| MCMC Services, LLC | 2,759 | 94.9% | 3.5x |
| National Medical Reviews, Inc. | 2,710 | 81.7% | 3.3x |
| EdiPhy Advisors, L.L.C. | 2,528 | 97.1% | 3.2x |
Open the live Georgia dashboard
Use the data explorer to filter Georgia by specialty, payer, and year, then compare the results with your own disputed claims.
FAQ
How many federal IDR disputes are in Georgia?
The Georgia page currently shows 71,510 CMS disputes in the benchmark dataset.
What is the provider win rate in Georgia?
The non-default provider win rate in Georgia is 88.3% in this dataset.
Why can Georgia 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.