What the federal record shows.
Win rates, award multiples, and what happens after the determination.
Providers win the large majority of federal IDR disputes, and winning awards routinely land well above the plan's qualifying payment amount. Both of those statements come from published federal data, not from Sydra. This page summarizes what that record shows, how to think about it against your own claims, and what happens once an arbitrator decides.
Provider win rates in federal IDR.
The published data favors providers. Analysis of CMS figures through mid 2025 found providers prevailing in roughly 88 percent of resolved disputes. The American College of Radiology reported the same direction in its review: disputes were decided in the provider's favor in the vast majority of cases.
Win rate is not a guarantee on any single claim. It reflects the pattern across a large body of determinations, and it rewards submissions that pair a credible offer with evidence an arbitrator can act on. A weak submission can lose a winnable claim.
How awards compare to the qualifying payment amount.
The qualifying payment amount, or QPA, is the plan's median contracted rate for the service, and it is the number plans lean on. In practice, arbitrators award above it most of the time. Reviews of the data found that the prevailing offer exceeded the QPA in roughly 87 percent of determinations, with a median award several times the in network rate.
That gap is the core of the opportunity. When a plan pays at or near the QPA on an out of network claim, the difference between that payment and a well supported IDR award is the revenue a practice leaves behind by not filing.
How much you can recover.
Recovery depends on the service, the geography, the strength of the submission, and the gap between what the plan paid and the defensible market rate. There is no flat figure, and any honest answer is a range tied to your own claims.
The reliable way to size it is to review a sample of denied or underpaid out of network explanations of benefits, identify the codes, and compare the plan's payment to comparable prior determinations for those codes. That comparison turns an abstract win rate into a dollar figure for your practice.
What happens after the IDR determination.
The IDRE issues a written determination that selects one offer and explains the basis. There is no appeal of the merits. The decision stands, which is why the quality of the submission matters so much going in.
When the provider's offer prevails, the plan owes the difference between what it already paid and the determined amount.
When the insurer does not pay the award.
The plan is generally required to pay the determined amount within 30 calendar days of the determination. Most do. When a plan does not, the determination is enforceable, and the provider has recourse to pursue payment.
Track the payment date the same way you track filing deadlines. An award that is won but not collected is not recovery. Following determinations through to payment is part of running IDR well.
The unclaimed revenue most practices leave behind.
Roughly 10 percent of eligible claims reach arbitration at all. Set that against an 88 percent provider win rate and the gap is not a dispute problem. It is a filing problem. The claims are winnable and they are not being filed, because filing takes longer than the claim appears to be worth.
That calculation changed on June 11, 2026, when the administrative fee dropped from $115 to $15.
Frequently asked
What is the provider win rate in IDR?
Analysis of CMS data through mid 2025 found providers prevailing in roughly 88 percent of resolved federal IDR disputes. Win rate reflects the pattern across many determinations and is not a guarantee on any single claim, since a weak submission can lose a winnable one.
How do IDR awards compare to the QPA?
The prevailing offer exceeded the qualifying payment amount in roughly 87 percent of determinations in published reviews, with a median award several times the in network rate. The gap between a plan's QPA based payment and a well supported award is the recovery opportunity.
How much can I recover through IDR?
Recovery depends on the service, geography, the strength of the submission, and the gap between the plan's payment and the defensible market rate. The reliable way to size it is to compare a sample of underpaid out of network claims to comparable prior determinations for those codes.
What if the insurer does not pay the IDR award?
Plans are generally required to pay the determined amount within 30 calendar days. When a plan does not, the determination is enforceable and the provider has recourse to pursue payment. Tracking the payment date is part of running IDR effectively.