Federal IDR vendor comparison
Pivotal Health is the stronger choice if line items per dispute is your top number: it averaged 4.1 in 2025 against a market of 2.6. Recourse is the broader choice for groups that judge IDR by what comes back, especially when teams want the whole claim feed screened, an ask built for each payer, and no new work for the billing team.
Get your free CMS filing benchmark2025 CMS data. Market = every other filer, Pivotal left out.
Gap column: green is better for the provider, red is worse.
| Metric | Pivotal Health | Market | Gap |
|---|---|---|---|
| Win rateShare of decided lines the provider won | 80% | 87% | ▼ 7 pts |
| Lost by defaultMissed a deadline or a fee. A loss with no hearing. | 5.0% of disputes | 1.8% | ▲ 2.8x as often |
| Award when it winsWinning offer as a multiple of QPA | 5.1x | 11.2x | ▼ 6.1x |
| Line items per disputeMore lines per dispute spreads the arbiter fee | 4.1 | 2.6 | ▲ 1.5 |
| Arbiter fee per line itemIDRE fee. The loser bears it. | $388 | $435 | ▼ $47 |
| Days to decisionMedian, filing to determination | 26 | 31 | ▼ 5 days |
Recourse: ask and evidence built per payer, every deadline tracked in software, disputes batched to the 50-line cap. Pricing for both is contingency; see below.
Outcomes. Pivotal won 80% of lines in 2025. Every other filer won 87%. When Pivotal won, the award was 5.1x QPA. For every other filer it was 11.2x. Inside the 2x to 4x ask band, Pivotal won 85% and every other filer won 90%.
Defaults. A default is a loss with no hearing: a missed deadline or an unpaid fee. Pivotal lost 5% of its disputes that way. Every other filer lost 1.8%. That was 29% of everything Pivotal lost.
Payers. Pivotal was below market at UnitedHealthcare (71% vs 85%), Anthem (68% vs 88%), MultiPlan (59% vs 80%) and Cigna (76% vs 82%). It was above market at Centene and Blue Cross Texas.
Line items. More line items per dispute spreads the arbiter fee across more lines. Pivotal ran 4.1 per dispute against a market of 2.6. From November 2026 the rule widens what can be batched, with a 50-line cap.
Both are contingency. Neither publishes a rate. Ask three things: the rate, whether it's charged on the award or on cash collected, and who pays the fees on a loss.
Choose Pivotal if you file through one of its RCM partners and line items per dispute is the number you manage to.
Choose Recourse if your payers include UHC, Anthem, Cigna or MultiPlan, you want the whole claim feed screened rather than a hand-picked list, or you want the process run without adding to your team's queue.
Depends what you measure. Pivotal Health ran 4.1 line items per dispute in 2025, above the market. Recourse screens the whole claim feed and builds the ask per payer. In 2025 CMS data Pivotal won 80% of lines; every other filer won 87%.
Pivotal Health is a full-service IDR filer with 20+ RCM partnerships. Recourse runs federal IDR end to end and uses payer-level CMS data to decide what to file and what to ask. Both are contingency.
Neither publishes a rate. In 2025 CMS data the arbiter fee on Pivotal's disputes was $388 per line item, below the $435 market median, because it files more lines per dispute. The winner gets that fee back. Total cost depends on the rate, what counts as recovered, and who pays fees on losses.
Yes for federal IDR. Recourse handles intake, eligibility, negotiation, filing, evidence and determination. If you file through an RCM partner, check whether that contract requires Pivotal.
Groups that already file through a Pivotal RCM partner and manage to line items per dispute.
Same file, same method, run on your domain.
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