Federal IDR guides
Should we run federal IDR in house or outsource it?
Most groups can win IDR in house. Few can file every claim that deserves it. What the cost per dispute does to recovery, and what to ask a vendor.
Verified September 11, 2026
Short answer
You can run federal IDR in house. Most groups that do end up filing only their biggest claims. The rules are not the problem. The work is. Each dispute takes hours across the notice, the packet, the fees, the portal, and the follow-up, and every payer does it a little differently.
That cost per dispute decides which claims get filed. When it is high, only large claims pay for themselves. When it is low, thousands of small claims do too. That is where most of the money is.
The question is not "can we win"
In 2025, providers won 86% of decided lines. Everyone wins most of the time. Win rate does not tell you much about a team or a vendor.
What differs is how much you win by. The winning offer was 399% of the QPA at the median. A quarter of winners were below 222%. A quarter were above 813%. The gap between a good number and an ordinary one is the whole return.
Picking that number well means knowing the payer, the code, the market, and the IDR entity. Doing that across a dozen payers and a hundred codes is hard for a billing team that also has a day job.
What changes with the cost per dispute
| High cost per dispute | Low cost per dispute | |
|---|---|---|
| Who does the work | People, by hand | Software, with people checking |
| Which claims get filed | The biggest few | Everything the math supports |
| What gets optimized | Getting the packet in | The number |
| Where the money comes from | A few large wins | Many small wins on top of those |
Think of your claims as a curve. A few are big. Most are small. A hand-run process lives in the tail. An automated one moves into the thick of the curve.
In house or out
| In house | Outsourced | |
|---|---|---|
| Control | Full | You set the rules, they run them |
| Cost | Staff time, per dispute | A share of what comes back, or a fee per dispute |
| Filing volume | Limited by hours | Limited by the math |
| Payer knowledge | Your payers only | Every payer they file against |
| Risk | Missed deadlines, filed on the wrong number | Vendor quality |
In house makes sense when your volume is small, your payers are few, and someone already owns the process.
Outsource when the claims you are not filing are worth more than the fee you would pay to file them. For most out-of-network groups, that is the case.
Questions to ask a vendor
Do you optimize for win rate or for the amount won?
How do you set the offer, and can I see it before it goes in?
What share of the claims I send do you actually file?
How do you check eligibility before paying the fees?
Recourse
Where Recourse fits
Recourse runs the whole process with software and a small operations team. That keeps the cost per dispute low enough to file the small claims, and it lets us set every offer from data on the payer, the code, and the entity. Our fee is a share of what we recover, so we are paid on the number, not on the win.
Sources
CMS Federal IDR Public Use Files, 2025 Q1 to Q4, line level, air ambulance excluded, deduplicated to the latest quarterly record. Win rate is provider offer selected over decided lines. Prevailing offer is expressed as a percent of the QPA.
Every number on this page comes from public CMS files or the federal rule. Our methodology explains how we count. Questions? sales@recoursehealth.com
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