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RUBRICWARD AI DOSSIER // TIER 2 AUTOPILOT (#01–#06, #11)
AR
ARDOI-MRF-CPT-29881
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Arkansas Insurance Department (AID) & CMS TiC Payer MRF Index
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Pulaski County, AR
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Filing / IDR Window: 2026-11-20
AR Commercial Payer TiC MRF & Federal NSA IDR Cohort — Multi-Specialty RCM
Commercial payer TiC MRF negotiated rate audit, CMS Medicare MPFS RVU/GPCI locality repricing, and ERISA 29 CFR § 2560.503-1 / Federal No Surprises Act (45 CFR § 149.510) IDR arbitration package for Multi-Specialty Surgical, ASC & E/M in AR (CPT 29881 Arthroscopy, CPT 45380 Endoscopy & CPT 99285 High-Severity E/M).
Cohort MRF 75th-Pct Value
$1,640,000
Target % of Medicare
227.5% MPFS
Statutory Authority
AR-GPCI-2026 (Ark. Code Ann. § 23-79-112 (12% 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 29881 | CPT 29881 Arthroscopy, CPT 45380 Endoscopy & CPT 99285 High-Severity E/M | CLAIM | 420 | $940.00 | $1,485.00 | $2,140.00 |
| CPT-45378 | Diagnostic Colonoscopy with Biopsy (ASC Facility + Pro) | CLAIM | 540 | $385.40 | $907.10 | $1,142.10 |
| CPT-43239 | Upper GI Endoscopy (EGD) with Biopsy | CLAIM | 190 | $558.83 | $1,315.30 | $1,656.04 |
2. Regional Peer Specialty Groups & EIN/NPI MRF Comparables (API #11)
Charles A. Clark, MdHarris Medical ClinicsAR Regional Multi-Specialty Surgical, ASC Associates PA