Federal IDR by payer
Payer outcomes, measured consistently.
Compare 2025 federal IDR volume, provider offer selection, prevailing-offer levels, defaults, and time to determination for the ten responding-party domains with the most lines in this analysis.
2025 Q1–Q4 · Air ambulance excluded · Closing-quarter basis
How this directory defines a payer
A payer here is the email domain of the party that responded in the dispute, as recorded by CMS. Recourse uses response domain because plan names are free text with hundreds of spelling variants. This is the same identity rule used by the report-card pipeline.
MultiPlan and ClearHealth Strategies are administrators or repricers acting for health plans rather than insurers. For multiplan.com disputes, parties most often entered Cigna as the plan. For clearhs.com disputes, parties most often entered UMR, a UnitedHealthcare company.
US provider win rate
86.4%
Defaults count as losses
Median prevailing offer
399%
Of QPA, uncapped median
Default-loss share
2.4%
Reported separately
Median determination
35 days
2025 US reference
Payer domains with the most claim lines
Open a payer page for the raw plan names parties entered, leave-one-out comparisons, closing-quarter tables, state and specialty mix, and named Q3–Q4 certified IDR entities.
| Payer | Response domain | Lines | Decided lines | Provider win rate | Median prevailing / QPA |
|---|---|---|---|---|---|
| UnitedHealthcare | uhc.com | 1,241,849 | 1,135,383 | 84.9% | 366% |
| Blue Cross Blue Shield of Texas | bcbstx.com | 1,197,912 | 1,148,437 | 87.9% | 606% |
| Aetna | aetna.com | 847,212 | 754,172 | 93.0% | 396% |
| MultiPlan | multiplan.com | 529,750 | 514,357 | 79.6% | 423% |
| Cigna | cigna.com | 327,284 | 326,296 | 81.6% | 271% |
| Anthem | anthem.com | 320,368 | 317,853 | 87.5% | 360% |
| ClearHealth Strategies | clearhs.com | 279,583 | 277,311 | 85.2% | 340% |
| Blue Cross Blue Shield of Arizona | azblue.com | 147,036 | 144,752 | 78.0% | 562% |
| Centene (Ambetter) | centene.com | 129,354 | 128,402 | 90.3% | 289% |
| Florida Blue | bcbsfl.com | 74,459 | 74,426 | 96.5% | 316% |
Methodology, sources, and limits
This directory uses all four 2025 CMS Federal IDR Public Use Files for out-of-network emergency and non-emergency items and services. Air ambulance is excluded. Lines are deduplicated to the latest quarterly record.
Win rate is the share of decided lines where the provider offer was selected. Lines with no decision are excluded from both numerator and denominator. Default decisions count as losses and are also shown separately. Disputes are dated by closing quarter, and quarterly figures are descriptive snapshots only.
Provider, payer, and prevailing-offer figures are uncapped medians as a percentage of QPA. Values are printed as computed, including unusually high medians.
Source: CMS Federal IDR Public Use Files, 2025 Q1 through Q4. Full calculation rules: Recourse methodology.
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