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RUBRICWARD AI DOSSIER // TIER 2 AUTOPILOT (#01–#06, #11)
US
CMS-NSA-IDR-2026-Q4-FED
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Centers for Medicare & Medicaid Services (CMS) CCIIO & EBSA Federal IDR Portal — National Docket
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National Federal Jurisdiction, US
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Filing / IDR Window: 2026-12-03
[CMS-NSA-IDR-2026-Q4-FED] Federal No Surprises Act (45 CFR 149.510) Certified IDR Entity Arbitration & ERISA 29 CFR 2560.503-1 Multi-Specialty Benchmark
National Federal No Surprises Act (45 CFR § 149.510) Independent Dispute Resolution (IDR) arbitration brief and ERISA (29 CFR § 2560.503-1 / 29 U.S.C. § 1024(b)(4)) administrative record demand challenging artificially deflated commercial Qualifying Payment Amounts (QPAs) under the Texas Medical Association (TMA III & IV) federal court rulings across Air Ambulance, Emergency Medicine, Anesthesiology, Radiology, and Out-of-Network Surgical Claims.
Cohort MRF 75th-Pct Value
$3,850,000
Target % of Medicare
15.0% MPFS
Statutory Authority
CMS-MPFS-2026-NAT (National Conversion Factor $33.29 & 45 CFR § 149.510 IDR Precedent)
ERISA / Timely-Filing Window
850 Days
1. Commercial Payer TiC MRF Allowed-Amount Benchmarks (API #02)
| CPT / DRG Code | Clinical Procedure Description | Unit | Cohort Claims | MRF 25th Pct | MRF Median (QPA) | MRF 75th Pct |
|---|---|---|---|---|---|---|
| IDR-SURG-01 | Complex Out-of-Network Inpatient/ASC Surgical Claim Batch (45 CFR 149.510 Batching Eligible) | BATCH | 180 | $3,200.00 | $9,450.00 | $12,400.00 |
| IDR-EMER-02 | High-Acuity Emergency Medicine & Trauma Critical Care IDR Batch (CPT 99285 / 99291) | BATCH | 420 | $1,150.00 | $3,180.00 | $4,150.00 |
| IDR-ANES-03 | Out-of-Network Surgical Anesthesiology Base + Time Unit IDR Batch (2.8x–3.4x QPA Precedent) | BATCH | 310 | $1,420.00 | $3,890.00 | $4,950.00 |
2. Regional Peer Specialty Groups & EIN/NPI MRF Comparables (API #11)
National Acute Care Physician PartnersAmerican Out-of-Network Surgical Recovery GroupApex Healthcare Revenue Cycle & IDR AdvisorsSummit Multi-Specialty Arbitration CollectiveVanguard Perioperative & Trauma Medical Group