Eliott Dear: Leading with FAIR Health — How a State IDR Submission Is Built

Every out-of-network dispute turns on one document: the submission the arbitrator reads. What goes into it, and what it leads with, is the work.

Eliott Dear builds every Claims Assassins submission around the same question: what does the arbitrator see first?

Four Pieces of Every Submission

The benchmark. FAIR Health 80th-percentile UCR data for the CPT code and the geography. It goes up front, not in an exhibit at the back.

The procedure. Procedure-specific complexity factors: what the case actually involved, and the circumstances a bare number leaves out.

The forum. The plan is sorted before anything is filed. A state-eligible claim goes to its state process: New York DFS, Texas DOI, Connecticut Insurance Department, New Jersey DOBI.

The signature. Eliott Dear reviews, signs and files the submission as an attorney. Not a billing template. Not a revenue cycle form.

Why the Benchmark Comes First

An arbitrator reads what is in front of them. A submission that leads with an independent benchmark puts that benchmark at the center of the record. A submission that leads with the carrier’s own number puts the carrier’s number there, and everything after it reads as an argument against it.

Eliott Dear builds every Claims Assassins filing in that order: benchmark, procedure, forum, signature.

Practical Steps for 2026 Filings

First, lead with FAIR Health benchmarks and procedure-specific complexity factors rather than a bare number.

Second, check that the benchmark matches the claim: the CPT code, the geo-zip and the date of service. A benchmark for the wrong code or the wrong zip is not a benchmark.

Third, sort the plan before anything is filed. The forum follows the plan, and every state-eligible claim goes to its own state process.

Tracking Every Docket

Every state runs its process on its own rules and its own deadlines. Eliott Dear tracks each docket and each deadline, because the practical mechanics of every dispute depend on them.

The work does not stop at filing. Claims Assassins follows every open dispute from submission through determination.