Resource
State vs. Federal IDR
How plan type, claim facts, and state law determine the correct out-of-network payment dispute process.
A claim-level decision
A state process may control when specified state law determines the total payment. Federal IDR generally applies to eligible claims not governed by such a law or an All-Payer Model.
Self-funded plans
ERISA self-funded plans generally use Federal IDR. Georgia, Maine, Nevada, New Jersey, Virginia, and Washington permit opt-in to a state process, so actual election status must be verified.