How to read the New Jersey IDR market
New Jersey 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 New Jersey disputes. Use them to spot where an underpaid out-of-network book may deserve a closer NSA workflow review.
Top payers in New Jersey federal IDR disputes
| Payer | Disputes | Provider win rate |
|---|---|---|
| Cigna / MultiPlan | 35,713 | 82.8% |
| UnitedHealthcare | 25,410 | 85.2% |
| Aetna | 18,879 | 91.8% |
| Horizon BCBS | 6,210 | 84% |
| UMR | 5,174 | 85.6% |
| EMBLEM HEALTH | 4,261 | 88.8% |
| UMR (clearhealthcloud.com) | 1,286 | 86.5% |
| Cigna (cigna.com) | 1,142 | 86% |
Top service codes in New Jersey
| Code | Service | Disputes | Provider win rate |
|---|---|---|---|
| 99284 | Emergency department visit for the evaluation and management of a patient, which... | 7,738 | 88.1% |
| 95938 | Short-latency somatosensory evoked potential study, stimulation of any/all... | 4,145 | 82.8% |
| 99283 | Emergency department visit for the evaluation and management of a patient.... | 2,940 | 89% |
| 95941 | Continuous intraoperative neurophysiology monitoring, from outside the operating... | 2,710 | 82% |
| 95939 | Central motor evoked potential study (transcranial motor stimulation); in upper... | 2,623 | 80.5% |
| 36475 | Endovenous ablation therapy of incompetent vein, extremity, inclusive of all... | 2,235 | 82.6% |
| 99285 | Emergency department visit, high severity, requiring urgent evaluation | 1,990 | 88.5% |
| 95861 | Needle electromyography; 2 extremities with or without related paraspinal areas | 1,960 | 83.6% |
Certified IDR entity mix
| Certified IDR entity | Disputes | Provider win rate | Median award |
|---|---|---|---|
| Maximus Federal Services, Inc. | 10,659 | 91.2% | 46.4x |
| EdiPhy Advisors, L.L.C. | 5,813 | 96.9% | 45.3x |
| Provider Resources, Inc. | 5,539 | 95.7% | 33.2x |
| iMPROve Health | 5,349 | 79.2% | 14.8x |
| C2C Innovative Solutions, Inc. | 5,071 | 92.3% | 26.8x |
| Federal Hearings and Appeals Services, Inc. | 4,572 | 77.1% | 16.7x |
| MCMC Services, LLC | 3,936 | 91.1% | 33.0x |
Open the live New Jersey dashboard
Use the data explorer to filter New Jersey by specialty, payer, and year, then compare the results with your own disputed claims.
FAQ
How many federal IDR disputes are in New Jersey?
The New Jersey page currently shows 105,105 CMS disputes in the benchmark dataset.
What is the provider win rate in New Jersey?
The non-default provider win rate in New Jersey is 85.7% in this dataset.
Why can New Jersey 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.