State IDR

Federal or state? It depends on the plan.

When a plan is state-regulated and the state has a law that sets the out-of-network rate, the state process applies. Self-funded employer plans almost always go federal. The engine routes every claim and cites why.

How a claim is routed

  1. Fully insured plan, in a state with its own law

    State process

    Arbitration, mediation or a state dispute program, on the state’s clock.

  2. Self-funded employer plan (ERISA)

    Federal IDR

    Unless the state lets self-funded plans opt in and this one did.

  3. Air ambulance

    Federal IDR

    Almost always. Federal aviation law limits what states can regulate about air carrier rates.

States at launch

Six state processes, one engine.

Summaries of each statute and regulator’s guidance as of October 12, 2026. Each page cites its source and flags where sources disagree.

At a glance.

State dispute processes at a glance
StateRegulator and forumSelf-funded plans
TexasTexas Department of Insurance (TDI). Arbitration for physicians and other providers; mediation for facilities.Self-funded employer plans are not regulated by TDI, so their claims go to the federal process.
New JerseyDepartment of Banking and Insurance (DOBI), with Maximus Federal as arbitrator. Binding final-offer arbitration.A self-funded plan that did not opt in on the date of service is excluded and goes to the federal process.
New YorkDepartment of Financial Services (DFS), with DFS-certified IDR entities. Independent dispute resolution, final-offer.Self-funded employer plans are outside DFS authority and go to the federal process.
FloridaAgency for Health Care Administration (AHCA), with Maximus as the resolution organization. Statewide Provider and Health Plan Claim Dispute Resolution Program.Florida’s program is a specified state law for the claims it covers, which keeps those claims out of the federal process. Self-funded plans go federal.
GeorgiaOffice of Commissioner of Insurance and Safety Fire. Arbitration through the Department’s GovLink portal.Self-funded employer plans go to the federal process unless state law brings them in.
WashingtonOffice of the Insurance Commissioner (OIC). Arbitration under the OIC.In March 2026 the OIC delayed moving state disputes to the federal process for at least two years and will revisit in 2028, so state arbitration remains the path for state-regulated plans.

A summary, not legal advice. Rules change; confirm with the regulator before relying on a date.

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Sources

  1. 11Texas Department of Insurance, SB 1264 and the independent dispute resolution process: request arbitration 20 to 90 days after first payment, 30-day informal settlement period, decision by day 51; facility claims go to mediation. Source
  2. 12Maximus Federal, New Jersey P.L. 2018, c. 32 out-of-network arbitration FAQs: 60 days to dispute the initial allowed amount and negotiate, arbitration within 60 days of the final offer, $1,000 threshold. Source
  3. 13New York Financial Services Law Article 6 (sections 601 to 608) and DFS independent dispute resolution entity guidance. Source
  4. 14Florida Statutes s. 408.7057, Statewide Provider and Health Plan Claim Dispute Resolution Program. Source
  5. 15Georgia Office of Commissioner of Insurance, Rule 120-2-106 (Surprise Billing) under O.C.G.A. 33-20E. Source
  6. 16Washington Office of the Insurance Commissioner, Balance Billing Protection Act arbitration (RCW 48.49), including the March 2026 decision to delay transition to the federal process. Source
  7. 17New Jersey Department of Banking and Insurance, out-of-network arbitration report: 28,671 arbitration requests received from 2018 through December 31, 2025. Source