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RUBRICWARD AI DOSSIER // TIER 2 AUTOPILOT (#01–#06, #11)
CT
CTDOI-MRF-CPT-99285-323
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Connecticut Insurance Department (CID) & CMS TiC Payer MRF Index
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Hartford County, CT
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Filing / IDR Window: 2026-11-21
[CTDOI-MRF-CPT-99285-323] Connecticut UHC, Anthem & BCBS-CT Commercial MRF Rate Disparity & NSA IDR Benchmark (CPT 99285 / 00100 Emergency & Anesthesia NSA IDR)
Commercial payer Transparency in Coverage (TiC) Machine-Readable File (MRF) negotiated rate audit and Federal No Surprises Act (NSA) IDR arbitration dossier for CPT 99285 / 00100 Emergency & Anesthesia NSA IDR in Connecticut (Conn. Gen. Stat. § 38a-816(15) (15% Prompt-Pay)).
Cohort MRF 75th-Pct Value
$2,345,000
Target % of Medicare
229.0% MPFS
Statutory Authority
CT-GPCI-2026 (Conn. Gen. Stat. § 38a-816(15) (15% Prompt-Pay))
ERISA / Timely-Filing Window
515 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 |
|---|---|---|---|---|---|---|
| CPT-99285 | Level 5 Emergency Department Visit (High Complexity) | CLAIM | 420 | $376.05 | $921.05 | $1,188.10 |
| CPT-00100 | Anesthesia for Salivary Gland / Complex Surgical Base + Time | CLAIM | 215 | $545.27 | $1,335.52 | $1,722.74 |
| CPT-99214-25 | Level 4 Established Patient Outpatient E/M with Separately Identifiable Modifier 25 | CLAIM | 1,200 | $115.00 | $172.00 | $204.00 |
2. Regional Peer Specialty Groups & EIN/NPI MRF Comparables (API #11)
Connecticut Specialty Surgical AssociatesConnecticut Ambulatory Surgery Center LLCRegional Medical Group of ConnecticutConnecticut Physician Billing & RCM Partners