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RUBRICWARD AI DOSSIER // TIER 2 AUTOPILOT (#01–#06, #11)
IN
INDOI-MRF-CPT-99285-318
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Indiana Department of Insurance (IDOI) & CMS TiC Payer MRF Index
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Marion County, IN
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Filing / IDR Window: 2026-11-26
[INDOI-MRF-CPT-99285-318] Anthem Blue Cross and Blue Shield of Indiana TiC MRF Rate Disparity: Interventional Cardiology & Outpatient Cath/EP Lab (CPT 93458 / 92928)
Commercial payer TiC MRF negotiated rate audit and Federal No Surprises Act (NSA) IDR arbitration dossier for In Interventional Cardiology & Outpatient Cath Lab procedures (CPT 93458 Left Heart Catheterization with Coronary Angiography, CPT 92928 Percutaneous Transcatheter Coronary Stent Placement, CPT 33249 ICD Pulse Generator & Lead Insertion, and CPT 93306 Complete Transthoracic Echocardiography) across Anthem Blue Cross Blue Shield IN & UnitedHealthcare.
Cohort MRF 75th-Pct Value
$2,270,000
Target % of Medicare
267.0% MPFS
Statutory Authority
IN-GPCI-2026 (IC 27-8-5.7-6 Prompt-Pay)
ERISA / Timely-Filing Window
180 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 | 460 | $324.30 | $794.30 | $1,024.60 |
| CPT-00100 | Anesthesia for Salivary Gland / Complex Surgical Base + Time | CLAIM | 215 | $470.24 | $1,151.73 | $1,485.67 |
| 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)
OrthoIndy Hospital & Outpatient Surgery CenterFort Wayne Orthopedics ASCIU Health Beltway Surgery CenterFort Wayne OrthopedicsRevele Healthcare RCM & eClinicalWorks