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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] Nh Anthem Blue Cross Blue Shield NH MRF Rate Disparity: Orthopedic Sports Medicine & Knee/Shoulder ASC (CPT 29881)
Commercial payer Transparency in Coverage (TiC) Machine-Readable File (MRF) rate audit and Federal No Surprises Act (NSA) IDR arbitration dossier for Nh Orthopedic & ASC surgical claims (CPT 29881 Knee Arthroscopy Meniscectomy, CPT 29827 Arthroscopic Rotator Cuff Repair, CPT 27447 Total Knee Arthroplasty, and CPT 29888 ACL Reconstruction) across Anthem Blue Cross Blue Shield NH & Harvard Pilgrim.
Cohort MRF 75th-Pct Value
$1,725,000
Target % of Medicare
241.0% MPFS
Statutory Authority
NH-GPCI-2026 (RSA 420-J:8-a (18% 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 | 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)
Concord Orthopaedics Surgery CenterDartmouth Health Nashua Ambulatory SurgeryAtlantic Orthopaedics & Sports Medicine PortsmouthCBS Medical Billing & ConsultingNew Hampshire NeuroSpine Institute