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RUBRICWARD AI DOSSIER // TIER 2 AUTOPILOT (#01–#06, #11)
MS
MSDOI-MRF-CPT-99285-333
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Mississippi Insurance Department (MID) & CMS TiC Payer MRF Index
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Hinds County, MS
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Filing / IDR Window: 2026-11-21
[MSDOI-MRF-CPT-99285-333] Blue Cross & Blue Shield of Mississippi TiC MRF Rate Disparity: Ophthalmology & Anterior Segment Cataract/MIGS ASC (CPT 66984)
Commercial payer TiC MRF negotiated rate benchmark and bilateral/MIGS multiple-procedure reduction (50% MPPR) audit for Ms Ophthalmic Ambulatory Surgery Centers (CPT 66984 Extracapsular Cataract Extraction with IOL, CPT 66991 Cataract with Anterior Segment Aqueous Drainage Device, CPT 66821 YAG Laser Capsulotomy, and CPT 65855 Trabeculoplasty) across Blue Cross & Blue Shield of Mississippi & Magnolia.
Cohort MRF 75th-Pct Value
$1,810,000
Target % of Medicare
206.0% MPFS
Statutory Authority
MS-GPCI-2026 (Miss. Code Ann. § 83-9-5 (18% Prompt-Pay))
ERISA / Timely-Filing Window
120 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 | 580 | $334.65 | $819.65 | $1,057.30 |
| CPT-00100 | Anesthesia for Salivary Gland / Complex Surgical Base + Time | CLAIM | 215 | $485.24 | $1,188.49 | $1,533.08 |
| 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)
Mississippi Sports Medicine & Orthopaedic Center FlowoodBienville Orthopaedic Specialists Gulfport ASCBaptist Medical Center Ridgeland Outpatient Surgery