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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] Indiana UHC, Anthem & BCBS-IN 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 Indiana (IC 27-8-5.7-6 Prompt-Pay).
Cohort MRF 75th-Pct Value
$1,420,000
Target % of Medicare
263.0% MPFS
Statutory Authority
IN-GPCI-2026 (IC 27-8-5.7-6 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 | 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)
Indiana Specialty Surgical AssociatesIndiana Ambulatory Surgery Center LLCRegional Medical Group of IndianaIndiana Physician Billing & RCM Partners