{
  "dataset": "Federal IDR dispute initiations by state or territory, second half of 2025",
  "period": {
    "start": "2025-07-01",
    "end": "2025-12-31",
    "label": "H2 2025"
  },
  "source": {
    "publisher": "U.S. Departments of Health and Human Services, Labor, and the Treasury",
    "document": "Supplemental Background on Federal Independent Dispute Resolution Public Use Files, July 1, 2025 – December 31, 2025, and the accompanying Federal IDR Supplemental Tables for 2025 Q3 and 2025 Q4",
    "sourceFormat": "XLSX",
    "sourceUpdated": "2026-07-22",
    "sourceUrl": "https://www.cms.gov/initiatives/no-surprise-billing/overview/policies-resources/independent-dispute-resolution-reports",
    "note": "Figures are transcribed from the published federal tables. Nothing here is estimated, modelled or adjusted. Where a value is a sum of the two quarters, the field name says so.",
    "table": "Table 7 — Federal IDR Dispute Initiations by State or Territory"
  },
  "fields": {
    "rank": "Rank by disputes initiated in the half-year, 1 = most",
    "state": "State or territory as named by CMS",
    "q3_2025": "Count of disputes, as published.",
    "q4_2025": "Count of disputes, as published.",
    "h2_2025": "Sum of the two quarters",
    "air_ambulance_h2_2025": "Disputes involving out-of-network air ambulance services, included in h2_2025",
    "specified_state_law": "Whether CMS flags the state as having a specified state law or All-Payer Model Agreement covering these disputes. This is what decides whether a given claim can go to a state process at all."
  },
  "note": "State rows sum to 1,376,390, which exceeds the national total of 1,372,563 published in Table 1. CMS publishes both; the difference is not explained in the report, so both figures are given as published rather than reconciled here.",
  "rows": [
    {
      "rank": 1,
      "state": "Texas",
      "q3_2025": 244275,
      "q4_2025": 280355,
      "h2_2025": 524630,
      "air_ambulance_h2_2025": 3767,
      "specified_state_law": true
    },
    {
      "rank": 2,
      "state": "Arizona",
      "q3_2025": 42725,
      "q4_2025": 44934,
      "h2_2025": 87659,
      "air_ambulance_h2_2025": 999,
      "specified_state_law": false
    },
    {
      "rank": 3,
      "state": "Florida",
      "q3_2025": 39238,
      "q4_2025": 40377,
      "h2_2025": 79615,
      "air_ambulance_h2_2025": 1088,
      "specified_state_law": true
    },
    {
      "rank": 4,
      "state": "New Jersey",
      "q3_2025": 35681,
      "q4_2025": 37151,
      "h2_2025": 72832,
      "air_ambulance_h2_2025": 134,
      "specified_state_law": true
    },
    {
      "rank": 5,
      "state": "California",
      "q3_2025": 32361,
      "q4_2025": 38053,
      "h2_2025": 70414,
      "air_ambulance_h2_2025": 1441,
      "specified_state_law": true
    },
    {
      "rank": 6,
      "state": "Georgia",
      "q3_2025": 25425,
      "q4_2025": 27584,
      "h2_2025": 53009,
      "air_ambulance_h2_2025": 1073,
      "specified_state_law": true
    },
    {
      "rank": 7,
      "state": "New York",
      "q3_2025": 24818,
      "q4_2025": 27232,
      "h2_2025": 52050,
      "air_ambulance_h2_2025": 54,
      "specified_state_law": true
    },
    {
      "rank": 8,
      "state": "Tennessee",
      "q3_2025": 23014,
      "q4_2025": 23778,
      "h2_2025": 46792,
      "air_ambulance_h2_2025": 2029,
      "specified_state_law": false
    },
    {
      "rank": 9,
      "state": "Indiana",
      "q3_2025": 18801,
      "q4_2025": 19079,
      "h2_2025": 37880,
      "air_ambulance_h2_2025": 401,
      "specified_state_law": false
    },
    {
      "rank": 10,
      "state": "Louisiana",
      "q3_2025": 17213,
      "q4_2025": 17992,
      "h2_2025": 35205,
      "air_ambulance_h2_2025": 271,
      "specified_state_law": false
    },
    {
      "rank": 11,
      "state": "Oklahoma",
      "q3_2025": 13375,
      "q4_2025": 15583,
      "h2_2025": 28958,
      "air_ambulance_h2_2025": 377,
      "specified_state_law": false
    },
    {
      "rank": 12,
      "state": "Ohio",
      "q3_2025": 12890,
      "q4_2025": 11857,
      "h2_2025": 24747,
      "air_ambulance_h2_2025": 637,
      "specified_state_law": true
    },
    {
      "rank": 13,
      "state": "Virginia",
      "q3_2025": 11646,
      "q4_2025": 12881,
      "h2_2025": 24527,
      "air_ambulance_h2_2025": 438,
      "specified_state_law": true
    },
    {
      "rank": 14,
      "state": "Nevada",
      "q3_2025": 10884,
      "q4_2025": 11456,
      "h2_2025": 22340,
      "air_ambulance_h2_2025": 273,
      "specified_state_law": true
    },
    {
      "rank": 15,
      "state": "Missouri",
      "q3_2025": 9690,
      "q4_2025": 10597,
      "h2_2025": 20287,
      "air_ambulance_h2_2025": 406,
      "specified_state_law": true
    },
    {
      "rank": 16,
      "state": "Arkansas",
      "q3_2025": 10263,
      "q4_2025": 9676,
      "h2_2025": 19939,
      "air_ambulance_h2_2025": 485,
      "specified_state_law": false
    },
    {
      "rank": 17,
      "state": "North Carolina",
      "q3_2025": 7727,
      "q4_2025": 7521,
      "h2_2025": 15248,
      "air_ambulance_h2_2025": 284,
      "specified_state_law": false
    },
    {
      "rank": 18,
      "state": "New Mexico",
      "q3_2025": 6358,
      "q4_2025": 6767,
      "h2_2025": 13125,
      "air_ambulance_h2_2025": 782,
      "specified_state_law": true
    },
    {
      "rank": 19,
      "state": "Colorado",
      "q3_2025": 5514,
      "q4_2025": 7251,
      "h2_2025": 12765,
      "air_ambulance_h2_2025": 279,
      "specified_state_law": true
    },
    {
      "rank": 20,
      "state": "South Carolina",
      "q3_2025": 6332,
      "q4_2025": 6059,
      "h2_2025": 12391,
      "air_ambulance_h2_2025": 335,
      "specified_state_law": false
    },
    {
      "rank": 21,
      "state": "Illinois",
      "q3_2025": 5658,
      "q4_2025": 6106,
      "h2_2025": 11764,
      "air_ambulance_h2_2025": 322,
      "specified_state_law": true
    },
    {
      "rank": 22,
      "state": "Alabama",
      "q3_2025": 5591,
      "q4_2025": 5500,
      "h2_2025": 11091,
      "air_ambulance_h2_2025": 668,
      "specified_state_law": false
    },
    {
      "rank": 23,
      "state": "Mississippi",
      "q3_2025": 5163,
      "q4_2025": 5405,
      "h2_2025": 10568,
      "air_ambulance_h2_2025": 769,
      "specified_state_law": false
    },
    {
      "rank": 24,
      "state": "Kentucky",
      "q3_2025": 4416,
      "q4_2025": 4508,
      "h2_2025": 8924,
      "air_ambulance_h2_2025": 345,
      "specified_state_law": false
    },
    {
      "rank": 25,
      "state": "Kansas",
      "q3_2025": 4106,
      "q4_2025": 4671,
      "h2_2025": 8777,
      "air_ambulance_h2_2025": 343,
      "specified_state_law": false
    },
    {
      "rank": 26,
      "state": "Pennsylvania",
      "q3_2025": 4409,
      "q4_2025": 4108,
      "h2_2025": 8517,
      "air_ambulance_h2_2025": 152,
      "specified_state_law": false
    },
    {
      "rank": 27,
      "state": "Michigan",
      "q3_2025": 4025,
      "q4_2025": 4443,
      "h2_2025": 8468,
      "air_ambulance_h2_2025": 334,
      "specified_state_law": true
    },
    {
      "rank": 28,
      "state": "Wisconsin",
      "q3_2025": 3268,
      "q4_2025": 4783,
      "h2_2025": 8051,
      "air_ambulance_h2_2025": 226,
      "specified_state_law": false
    },
    {
      "rank": 29,
      "state": "Connecticut",
      "q3_2025": 3161,
      "q4_2025": 3681,
      "h2_2025": 6842,
      "air_ambulance_h2_2025": 13,
      "specified_state_law": true
    },
    {
      "rank": 30,
      "state": "Idaho",
      "q3_2025": 2867,
      "q4_2025": 2775,
      "h2_2025": 5642,
      "air_ambulance_h2_2025": 71,
      "specified_state_law": false
    },
    {
      "rank": 31,
      "state": "Maryland",
      "q3_2025": 2118,
      "q4_2025": 2942,
      "h2_2025": 5060,
      "air_ambulance_h2_2025": 227,
      "specified_state_law": true
    },
    {
      "rank": 32,
      "state": "Washington",
      "q3_2025": 2260,
      "q4_2025": 2794,
      "h2_2025": 5054,
      "air_ambulance_h2_2025": 257,
      "specified_state_law": true
    },
    {
      "rank": 33,
      "state": "Alaska",
      "q3_2025": 335,
      "q4_2025": 2290,
      "h2_2025": 2625,
      "air_ambulance_h2_2025": 342,
      "specified_state_law": false
    },
    {
      "rank": 34,
      "state": "West Virginia",
      "q3_2025": 1295,
      "q4_2025": 1261,
      "h2_2025": 2556,
      "air_ambulance_h2_2025": 173,
      "specified_state_law": false
    },
    {
      "rank": 35,
      "state": "Massachusetts",
      "q3_2025": 1172,
      "q4_2025": 1211,
      "h2_2025": 2383,
      "air_ambulance_h2_2025": 49,
      "specified_state_law": false
    },
    {
      "rank": 36,
      "state": "South Dakota",
      "q3_2025": 1150,
      "q4_2025": 1212,
      "h2_2025": 2362,
      "air_ambulance_h2_2025": 66,
      "specified_state_law": false
    },
    {
      "rank": 37,
      "state": "Utah",
      "q3_2025": 562,
      "q4_2025": 1321,
      "h2_2025": 1883,
      "air_ambulance_h2_2025": 40,
      "specified_state_law": false
    },
    {
      "rank": 38,
      "state": "Delaware",
      "q3_2025": 704,
      "q4_2025": 1019,
      "h2_2025": 1723,
      "air_ambulance_h2_2025": 11,
      "specified_state_law": true
    },
    {
      "rank": 39,
      "state": "Oregon",
      "q3_2025": 879,
      "q4_2025": 802,
      "h2_2025": 1681,
      "air_ambulance_h2_2025": 411,
      "specified_state_law": false
    },
    {
      "rank": 40,
      "state": "Iowa",
      "q3_2025": 757,
      "q4_2025": 871,
      "h2_2025": 1628,
      "air_ambulance_h2_2025": 72,
      "specified_state_law": false
    },
    {
      "rank": 41,
      "state": "Maine",
      "q3_2025": 620,
      "q4_2025": 735,
      "h2_2025": 1355,
      "air_ambulance_h2_2025": 15,
      "specified_state_law": true
    },
    {
      "rank": 42,
      "state": "Rhode Island",
      "q3_2025": 561,
      "q4_2025": 550,
      "h2_2025": 1111,
      "air_ambulance_h2_2025": 5,
      "specified_state_law": false
    },
    {
      "rank": 43,
      "state": "Nebraska",
      "q3_2025": 260,
      "q4_2025": 420,
      "h2_2025": 680,
      "air_ambulance_h2_2025": 112,
      "specified_state_law": true
    },
    {
      "rank": 44,
      "state": "Wyoming",
      "q3_2025": 329,
      "q4_2025": 338,
      "h2_2025": 667,
      "air_ambulance_h2_2025": 546,
      "specified_state_law": false
    },
    {
      "rank": 45,
      "state": "New Hampshire",
      "q3_2025": 297,
      "q4_2025": 356,
      "h2_2025": 653,
      "air_ambulance_h2_2025": 11,
      "specified_state_law": true
    },
    {
      "rank": 46,
      "state": "Hawaii",
      "q3_2025": 306,
      "q4_2025": 284,
      "h2_2025": 590,
      "air_ambulance_h2_2025": 65,
      "specified_state_law": false
    },
    {
      "rank": 47,
      "state": "Washington DC",
      "q3_2025": 244,
      "q4_2025": 221,
      "h2_2025": 465,
      "air_ambulance_h2_2025": 0,
      "specified_state_law": false
    },
    {
      "rank": 48,
      "state": "Minnesota",
      "q3_2025": 239,
      "q4_2025": 165,
      "h2_2025": 404,
      "air_ambulance_h2_2025": 44,
      "specified_state_law": false
    },
    {
      "rank": 49,
      "state": "Montana",
      "q3_2025": 154,
      "q4_2025": 176,
      "h2_2025": 330,
      "air_ambulance_h2_2025": 70,
      "specified_state_law": false
    },
    {
      "rank": 50,
      "state": "North Dakota",
      "q3_2025": 50,
      "q4_2025": 52,
      "h2_2025": 102,
      "air_ambulance_h2_2025": 85,
      "specified_state_law": false
    },
    {
      "rank": 51,
      "state": "Vermont",
      "q3_2025": 5,
      "q4_2025": 4,
      "h2_2025": 9,
      "air_ambulance_h2_2025": 0,
      "specified_state_law": false
    },
    {
      "rank": 52,
      "state": "American Samoa",
      "q3_2025": 3,
      "q4_2025": 2,
      "h2_2025": 5,
      "air_ambulance_h2_2025": 0,
      "specified_state_law": false
    },
    {
      "rank": 53,
      "state": "Puerto Rico",
      "q3_2025": 3,
      "q4_2025": 2,
      "h2_2025": 5,
      "air_ambulance_h2_2025": 0,
      "specified_state_law": false
    },
    {
      "rank": 54,
      "state": "Northern Mariana Islands",
      "q3_2025": 2,
      "q4_2025": 0,
      "h2_2025": 2,
      "air_ambulance_h2_2025": 0,
      "specified_state_law": false
    },
    {
      "rank": 55,
      "state": "Guam",
      "q3_2025": 0,
      "q4_2025": 0,
      "h2_2025": 0,
      "air_ambulance_h2_2025": 0,
      "specified_state_law": false
    },
    {
      "rank": 56,
      "state": "US Virgin Islands",
      "q3_2025": 0,
      "q4_2025": 0,
      "h2_2025": 0,
      "air_ambulance_h2_2025": 0,
      "specified_state_law": false
    }
  ]
}