Where Physicians Are Actually Filing
Federal arbitration volume is not spread evenly across the country. Texas alone accounts for more disputes than the next three states combined. This is the full CMS ranking for the second half of 2025, together with the states that have their own specified state law — the flag that decides whether a claim belongs in the federal process at all.
Federal IDR Initiations by State, H2 2025
| # | State or territory | Disputes initiated | Of which air ambulance | Specified state law |
|---|---|---|---|---|
| 1 | Texas | 524,630 | 3,767 | Yes |
| 2 | Arizona | 87,659 | 999 | — |
| 3 | Florida | 79,615 | 1,088 | Yes |
| 4 | New Jersey | 72,832 | 134 | Yes |
| 5 | California | 70,414 | 1,441 | Yes |
| 6 | Georgia | 53,009 | 1,073 | Yes |
| 7 | New York | 52,050 | 54 | Yes |
| 8 | Tennessee | 46,792 | 2,029 | — |
| 9 | Indiana | 37,880 | 401 | — |
| 10 | Louisiana | 35,205 | 271 | — |
| 11 | Oklahoma | 28,958 | 377 | — |
| 12 | Ohio | 24,747 | 637 | Yes |
| 13 | Virginia | 24,527 | 438 | Yes |
| 14 | Nevada | 22,340 | 273 | Yes |
| 15 | Missouri | 20,287 | 406 | Yes |
| 16 | Arkansas | 19,939 | 485 | — |
| 17 | North Carolina | 15,248 | 284 | — |
| 18 | New Mexico | 13,125 | 782 | Yes |
| 19 | Colorado | 12,765 | 279 | Yes |
| 20 | South Carolina | 12,391 | 335 | — |
| 21 | Illinois | 11,764 | 322 | Yes |
| 22 | Alabama | 11,091 | 668 | — |
| 23 | Mississippi | 10,568 | 769 | — |
| 24 | Kentucky | 8,924 | 345 | — |
| 25 | Kansas | 8,777 | 343 | — |
| 26 | Pennsylvania | 8,517 | 152 | — |
| 27 | Michigan | 8,468 | 334 | Yes |
| 28 | Wisconsin | 8,051 | 226 | — |
| 29 | Connecticut | 6,842 | 13 | Yes |
| 30 | Idaho | 5,642 | 71 | — |
| 31 | Maryland | 5,060 | 227 | Yes |
| 32 | Washington | 5,054 | 257 | Yes |
| 33 | Alaska | 2,625 | 342 | — |
| 34 | West Virginia | 2,556 | 173 | — |
| 35 | Massachusetts | 2,383 | 49 | — |
| 36 | South Dakota | 2,362 | 66 | — |
| 37 | Utah | 1,883 | 40 | — |
| 38 | Delaware | 1,723 | 11 | Yes |
| 39 | Oregon | 1,681 | 411 | — |
| 40 | Iowa | 1,628 | 72 | — |
| 41 | Maine | 1,355 | 15 | Yes |
| 42 | Rhode Island | 1,111 | 5 | — |
| 43 | Nebraska | 680 | 112 | Yes |
| 44 | Wyoming | 667 | 546 | — |
| 45 | New Hampshire | 653 | 11 | Yes |
| 46 | Hawaii | 590 | 65 | — |
| 47 | Washington DC | 465 | 0 | — |
| 48 | Minnesota | 404 | 44 | — |
| 49 | Montana | 330 | 70 | — |
| 50 | North Dakota | 102 | 85 | — |
| 51 | Vermont | 9 | 0 | — |
| 52 | American Samoa | 5 | 0 | — |
| 53 | Puerto Rico | 5 | 0 | — |
| 54 | Northern Mariana Islands | 2 | 0 | — |
Reading the last column. CMS marks states that have a specified state law or an All-Payer Model Agreement applying to certain out-of-network payment disputes. In those states the route depends on the claim: state law generally cannot reach self-funded ERISA plans, so those disputes still go federal. Getting the route wrong is a common way to lose a claim on eligibility rather than on the merits.
Source: CMS, Federal IDR Supplemental Tables, Q3 and Q4 2025, Table 7. CMS notes that batched disputes spanning several states are counted in each state, so the state figures sum to more than the national total. Published by CMS here.
State Briefings
We are based in California and work federal IDR claims for practices in every state — the process runs through the Departments' portal and is identical wherever the practice sits.