Federal IDR payer outcomes
Blue Cross Blue Shield of Arizona federal IDR outcomes
See 2025 CMS federal IDR volume, provider offer selection, leave-one-out comparisons, offer levels, defaults, states, specialties, and certified IDR entity mix for responses from azblue.com.
2025 Q1–Q4 · Response domain: azblue.com · Closing-quarter basis
How did providers fare against Blue Cross Blue Shield of Arizona in federal IDR?
In 2025, providers had their offer selected on 78.0% of 144,752 decided claim lines answered from azblue.com, across 44,173 disputes. Defaults count as losses in that rate and are reported separately below.
Claim lines
147,036
Across 44,173 disputes
Decided lines
144,752
No-decision lines excluded
Provider win rate
78.0%
Defaults count as losses
Median prevailing offer
562%
Of QPA, uncapped median
968% of QPA median provider offer.
199% of QPA median payer offer.
3.8% default-loss share.
31 days median determination.
Compared with all other payer domains
| Population | Provider win rate | Median prevailing / QPA | Default-loss share |
|---|---|---|---|
| Blue Cross Blue Shield of Arizona | 78.0% | 562% | 3.8% |
| All other payer domains | 86.7% | 397% | 2.4% |
Payer identity
What azblue.com represents
This page groups disputes by the email domain of the responding party recorded by CMS. The report-card pipeline uses response domain because plan names are free text with hundreds of spelling variants.
Plan names as entered by parties
| Plan name | Lines |
|---|---|
| BLUE CROSS AND BLUE SHIELD OF ARIZONA | 35,755 |
| Blue Cross Blue Shield of Arizona | 29,937 |
| BCBSAZ | 22,915 |
| BLUE CROSS AND BLUE SHIELD OF ARIZONA, I | 8,254 |
| BCBS | 6,737 |
Plan type mix
| Plan type | Lines |
|---|---|
| Either partially or fully self-insured private (employment-based) group health plan | 132,263 |
| Federal Employees Health Benefits (FEHB) Carrier | 5,595 |
| Individual health insurance issuer | 4,476 |
| No Plan/Issuer Response | 3,863 |
Blue Cross Blue Shield of Arizona outcomes by closing quarter
The quarter is the quarter in which a dispute closed. These figures are descriptive snapshots. They do not establish a directional pattern because CMS publishes in arrears and can restate records.
| Closing quarter | Lines | Decided lines | Provider win rate |
|---|---|---|---|
| 2025 Q1 | 37,793 | 37,221 | 80.0% |
| 2025 Q2 | 46,341 | 45,808 | 77.1% |
| 2025 Q3 | 33,952 | 33,371 | 78.3% |
| 2025 Q4 | 28,950 | 28,352 | 76.3% |
Where Blue Cross Blue Shield of Arizona disputes occurred
State is the CMS Location of Service field. Prevailing-offer figures are uncapped medians and are printed as computed, including unusually high values.
Specialty mix
Usable specialty labels are grouped into provider categories. The unknown bucket is omitted.
| Specialty | Lines | Provider win rate |
|---|---|---|
| Emergency | 82,953 | 81.4% |
| Hospital medicine | 35,673 | 75.3% |
| Anesthesia | 18,603 | 78.0% |
| Neuromonitoring | 2,795 | 85.2% |
| Surgery | 1,196 | 85.0% |
| Other | 583 | 78.6% |
Certified IDR entity mix
CMS added the named certified IDR entity field beginning with the 2025 Q3 file. This table covers named Q3 and Q4 records only and should not be compared with the full-year payer totals.
| Certified IDR entity | Lines | Provider win rate |
|---|---|---|
| Federal Hearings and Appeals Services, Inc. | 23,105 | 76.8% |
| Maximus Federal Services, Inc. | 8,244 | 86.8% |
| C2C Innovative Solutions, Inc. | 7,846 | 67.2% |
| Island Peer Review Organization | 7,332 | 94.4% |
| Provider Resources, Inc. | 3,673 | 80.8% |
| MCMC Services, LLC | 3,572 | 71.3% |
Methodology, sources, and limits
This page 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.
A payer is the email domain of the responding party recorded by CMS. This page includes responses from azblue.com. Recourse uses response domain because plan names are free text with hundreds of spelling variants.
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.
Provider, payer, and prevailing-offer figures are uncapped medians as a percentage of QPA. Values are printed as computed, including unusually high medians. Leave-one-out comparisons include all other payer response domains.
Source: CMS Federal IDR Public Use Files, 2025 Q1 through Q4. Full calculation rules: Recourse methodology. Browse all profiles: payer outcomes directory.
What the Blue Cross Blue Shield of Arizona pattern means for provider groups
Providers in disputes answered from azblue.com had a 78.0% offer-selection rate, 8.7 percentage points below the 86.7% rate across all other payer domains. The median prevailing offer moved in the opposite direction, at 562% of QPA versus 397%, while defaults were more common at 3.8% versus 2.4%. Almost every line came from Arizona; the tiny out-of-state rows carry high uncapped medians and should be interpreted only alongside their very small line counts.
A provider group's own result can differ because its specialties, services, states, offers, defaults, and filing operations differ from this payer-domain population. The report-card CTA below applies the same measurement framework to the group's own claims.
Your claims involving Blue Cross Blue Shield of Arizona
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