Eliott Dear: State IDR in 2026 — What Changed, What Comes Next

Commercial out-of-network reimbursement has moved a long way since 2022. For a non-par physician, the question in 2026 is which state IDR system a claim belongs in, and what the submission has to carry.

What Changed — Reimbursement

Median commercial out-of-network reimbursement has declined in most specialties since 2022. Anesthesiology, emergency medicine, and certain surgical sub-specialties have been hardest hit.

Provider underpayment now dominates non-par revenue cycle conversations. The allowed amount on the EOB is the carrier’s number, and the physician is the one who has to contest it.

What Exists — State IDR

New York’s IDR system, administered by DFS, has the longest track record of any state IDR system. Texas, New Jersey, Connecticut, Georgia, and New Mexico operate their own IDR regimes with state-regulator backing.

What Comes First — The Plan Sort

Every claim starts with the plan. Fully-insured or not, which state, which carrier — that sort decides where the claim goes before a single page of the submission is built.

What Is Coming Next — State by State

State IDR systems have proliferated, each with state-regulator backing.

Eliott Dear’s playbook for 2026 and forward: state IDR whenever the policy is fully-insured in a state-IDR state, starting with New York; appeal track for Medicaid Managed Care and Medicare Advantage claims.