How to read the New York IDR market
New York 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 York disputes. Use them to spot where an underpaid out-of-network book may deserve a closer NSA workflow review.
Top payers in New York federal IDR disputes
| Payer | Disputes | Provider win rate |
|---|---|---|
| UnitedHealthcare | 29,252 | 84.1% |
| Aetna | 16,754 | 92.1% |
| Anthem Blue Cross | 14,648 | 88.5% |
| Cigna / MultiPlan | 5,326 | 82.5% |
| UMR | 3,116 | 91.1% |
| EMBLEM HEALTH | 3,073 | 87.7% |
| UMR (clearhealthcloud.com) | 1,792 | 88.2% |
| REDACTEDSEIU National Benefit Fund | 1,557 | 68.5% |
Top service codes in New York
| Code | Service | Disputes | Provider win rate |
|---|---|---|---|
| 99284 | Emergency department visit for the evaluation and management of a patient, which... | 7,202 | 91% |
| 99285 | Emergency department visit, high severity, requiring urgent evaluation | 5,391 | 90.6% |
| 95938 | Short-latency somatosensory evoked potential study, stimulation of any/all... | 2,651 | 83.3% |
| 99283 | Emergency department visit for the evaluation and management of a patient.... | 2,373 | 91.2% |
| 71045 | Chest X-ray, single view | 1,873 | 91.4% |
| 74177 | CT scan of the abdomen and pelvis with IV contrast | 1,836 | 92.4% |
| 19318 | Breast reduction | 1,702 | 82.8% |
| 70450 | CT scan of the head/brain without contrast | 1,612 | 91.9% |
Certified IDR entity mix
| Certified IDR entity | Disputes | Provider win rate | Median award |
|---|---|---|---|
| Federal Hearings and Appeals Services, Inc. | 5,428 | 79.6% | 4.9x |
| Maximus Federal Services, Inc. | 5,156 | 92% | 36.3x |
| C2C Innovative Solutions, Inc. | 3,792 | 89.7% | 8.2x |
| EdiPhy Advisors, L.L.C. | 3,753 | 95.1% | 15.2x |
| Provider Resources, Inc. | 3,662 | 96.3% | 16.5x |
| MCMC Services, LLC | 2,968 | 91.9% | 11.6x |
| iMPROve Health | 2,576 | 79.5% | 7.2x |
Open the live New York dashboard
Use the data explorer to filter New York by specialty, payer, and year, then compare the results with your own disputed claims.
FAQ
How many federal IDR disputes are in New York?
The New York page currently shows 79,595 CMS disputes in the benchmark dataset.
What is the provider win rate in New York?
The non-default provider win rate in New York is 86.7% in this dataset.
Why can New York 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.