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RUBRICWARD AI DOSSIER // TIER 2 AUTOPILOT (#01–#06, #11)
NH
NHDOI-MRF-CPT-99285-338
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New Hampshire Insurance Department (NHID) & CMS TiC Payer MRF Index
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Hillsborough County, NH
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Filing / IDR Window: 2026-11-26
[NHDOI-MRF-CPT-99285-338] New Hampshire UHC, Anthem & BCBS-NH 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 New Hampshire (RSA 420-J:8-a (18% Prompt-Pay)).
Cohort MRF 75th-Pct Value
$2,160,000
Target % of Medicare
203.5% MPFS
Statutory Authority
NH-GPCI-2026 (RSA 420-J:8-a (18% 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 | 540 | $313.95 | $768.95 | $991.90 |
| CPT-00100 | Anesthesia for Salivary Gland / Complex Surgical Base + Time | CLAIM | 215 | $455.23 | $1,114.98 | $1,438.25 |
| 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)
New Hampshire Specialty Surgical AssociatesNew Hampshire Ambulatory Surgery Center LLCRegional Medical Group of New HampshireNew Hampshire Physician Billing & RCM Partners