IDR outcomes
What three years of federal disputes say
Every quarter CMS publishes every federal payment dispute an arbiter decided. We read all of them, because this is the record our work is judged against. Here is what it says, in the order a practice asks.
8,225,470 line items in 3,393,003 decided disputes, 2023 Q1 to 2025 Q4 · national public data, not Spectare's results · data version 2025Q4-166d8d
01Who wins
Providers win most of the disputes they take to an arbiter.
- 86%
- of contested disputes won by the provider1,753,288 contested disputes, the latest four quarters (2025 Q1 to 2025 Q4)
- 2,180,938
- disputes decided in those four quarters5,722,653 line items
- 75% to 89%
- the range of the win rate across all twelve quarters2023 Q1 to 2025 Q4
A dispute is contested when both sides made an offer and paid their fee. Default decisions, where one side did neither, were 20% of disputes; they are left out of the win rate and counted separately. The arbiter cannot split the difference, so a win means the arbiter took the provider's number.
Line items decided per quarter, and the share providers won
Bars: line items with a payment determination in the quarter. Line: the share of contested disputes decided for the provider or facility. The 2025 volumes include the backlog the arbiters cleared that year, so a quarter's decisions are not a quarter's new disputes.
02How much
The award is usually several times the payer's own rate.
- 4.0×
- the payer's rate: the median awardmiddle half 2.2× to 8.1×
- $611
- the median award in dollarsagainst a median payer's rate of $159
The payer's rate is its qualifying payment amount: its own median in-network rate, by its own math. Payers' final offers ran a median 1.00× that rate and providers asked 4.7×; the arbiter took the provider's number 86% of the time. See it code by code.
From what the payer paid first to what the arbiter awarded
Medians in dollars across every decided line item, the latest four quarters (2025 Q1 to 2025 Q4), national. First payments are in the files from 2025 Q3.
The anonymised dollar file; rates under $1 excluded. The award is the offer the arbiter chose.
03Which services
Emergency medicine is most of it. The specialties that never chose the patient are most of the rest.
- 33%
- of line items were emergency visitsthe latest four quarters (2025 Q1 to 2025 Q4)
- 44%
- were radiology, pathology, anesthesia or neuromonitoring
Grouped by CMS's own code ranges. The bar shows how contested line items were decided, provider against payer; the count is every line item in the group. The win rate holds across groups; the multiples of the payer's rate differ a great deal. Every group, by quarter and state.
Decided for the provider, by service group
the latest four quarters (2025 Q1 to 2025 Q4), national.
04Where
Texas files 44% of it. The win rate holds everywhere.
- 44%
- of line items were for care given in Texasthe latest four quarters (2025 Q1 to 2025 Q4)
- 79% to 91%
- the provider win rate across the fifteen busiest states
The state is where the service was given, as CMS records it. Texas is where the federal process does most of its work; the record is deep enough in most states to read on its own. The record where you practice.
The ten busiest states
Line items decided, with each state's provider win rate and median award against the payer's rate. Each opens the state's own view.
05What gets thrown out
One filed dispute in five is thrown out before an arbiter sees it.
- 20%
- of disputes closed in 2025 Q4 were found ineligible135,866 of 692,048
- 42%
- of disputes had their eligibility challenged by the payer
A dispute found ineligible costs the filer its fees and its time, and never reaches an arbiter. Screening before filing is most of the work, and it is most of ours: the claims that do not qualify stay on your list with the reason, and some go to an ordinary appeal instead.
How the 692,048 disputes closed in 2025 Q4 ended
| Decided by an arbiter | 542,138 |
| Found ineligible | 135,866 |
| Withdrawn, settled or closed for another reason | 14,044 |
| Filed in the quarter | 719,118 |
| Administrative fees collected by HHS | $143.1M |
| Paid to arbiters | $304.8M |
CMS Federal IDR Supplemental Tables, 2025 Q4, tables 1, 4, 5 and 6. Closures in a quarter include disputes filed earlier.
06How long
A decision takes about 31 business days. The money is due 30 calendar days after it.
- 31
- business days from filing to decision, median50% of decisions came within 30
- $545
- the arbiter's fee the losing side paid, median31% of disputes were batched
Medians over the latest four quarters (2025 Q1 to 2025 Q4), national. The rules then give the payer 30 calendar days to pay the award; the files record decisions, not payments, so collection is a separate job. Batching spreads the fees over several lines, and from November 2026 a batch may carry up to 50. Whether one line is worth filing.
What the files cannot say
- Whether an award was paid. The files record decisions, not collections.
- Why a particular dispute was ineligible, or anything about disputes that never reached a decision, beyond the counts.
- What in-network contracts pay. The payer's rate is the payer's own median, as the filer reported it; some are nominal or unit prices, which makes a few multiples absurd. Medians and percentiles, never averages, are used throughout.
- Anything about a patient. Nothing here is a prediction of any claim's outcome, and nothing is Spectare's own result.
How we count: every source, rule and check, and the limits of the files.
The full tables and charts are easiest to read on a larger screen. On a phone, start with the figures above, or ask for a free claims review and we will read your own remittances for you.
07Look up your own situation
IDR outcomes by state, by code, and for one claim line
- 02
Your state
How disputes went where you practice, read back to you for any period: who filed, who won, by how much, how long it took, and which payers and arbiters were on the other side. A CSV of any view.
- 03
Code by code
One service code at a time: the dollar stack from the payer's first payment to the award, the ladder of past awards, the trend, and the states, metro areas and payers, with the Medicare amount for context.
- 04
Worth filing?
Type in the rate and payment from one remittance line. A verdict, the arithmetic behind it, and where your numbers sit in the record. Nothing you type leaves the browser.
Have claims you'd like reviewed?
The outcomes say what has happened to other practices' claims. A free claims review says what is in yours: which lines qualify, the deadlines still open, and what we expect to recover. No patient information is needed for the first conversation.
Source: Centers for Medicare & Medicaid Services. Federal IDR Public Use File [Data file and data dictionary]. Retrieved from https://www.cms.gov/nosurprises/policies-and-resources/reports. Spectare Health's reading; figures are national public data about federal disputes, not Spectare's results, and not a guarantee of any outcome. Data version 2025Q4-166d8d, prepared 2026-10-14.