Federal IDR payer outcomes
MultiPlan 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 multiplan.com.
2025 Q1–Q4 · Response domain: multiplan.com · Closing-quarter basis
How did providers fare against MultiPlan in federal IDR?
In 2025, providers had their offer selected on 79.6% of 514,357 decided claim lines answered from multiplan.com, across 221,077 disputes. Defaults count as losses in that rate and are reported separately below.
Claim lines
529,750
Across 221,077 disputes
Decided lines
514,357
No-decision lines excluded
Provider win rate
79.6%
Defaults count as losses
Median prevailing offer
423%
Of QPA, uncapped median
478% of QPA median provider offer.
237% of QPA median payer offer.
3.6% default-loss share.
45 days median determination.
Compared with all other payer domains
| Population | Provider win rate | Median prevailing / QPA | Default-loss share |
|---|---|---|---|
| MultiPlan | 79.6% | 423% | 3.6% |
| All other payer domains | 87.1% | 395% | 2.3% |
Payer identity
What multiplan.com represents
MultiPlan is an administrator or repricer acting for health plans, not the insurer identified by the page label. This page groups disputes where the responding party used a multiplan.com email address. Parties most often entered the plan as Cigna. 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 |
|---|---|
| Cigna | 107,974 |
| Cigna Healthcare | 76,326 |
| CIGNA | 42,658 |
| Cigna Health and Life Insurance Company | 35,142 |
| ARKANSAS BLUE CROSS AND BLUE SHIELD | 24,004 |
Plan type mix
| Plan type | Lines |
|---|---|
| Either partially or fully self-insured private (employment-based) group health plan | 433,616 |
| Fully insured private group health plan | 51,741 |
| No Plan/Issuer Response | 35,152 |
| Individual health insurance issuer | 8,727 |
MultiPlan 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 | 97,203 | 94,430 | 81.2% |
| 2025 Q2 | 151,231 | 145,289 | 82.5% |
| 2025 Q3 | 151,974 | 147,907 | 78.9% |
| 2025 Q4 | 129,342 | 126,731 | 75.8% |
Where MultiPlan 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 | 249,470 | 77.3% |
| Radiology | 81,263 | 93.8% |
| Anesthesia | 62,476 | 81.1% |
| Hospital medicine | 52,349 | 81.5% |
| Surgery | 26,667 | 83.2% |
| Neuromonitoring | 16,706 | 80.5% |
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. | 34,157 | 75.9% |
| Maximus Federal Services, Inc. | 34,067 | 90.6% |
| Island Peer Review Organization | 31,796 | 94.9% |
| iMPROve Health | 31,352 | 77.7% |
| Network Medical Review Company, Ltd. | 31,307 | 63.7% |
| C2C Innovative Solutions, Inc. | 25,683 | 82.8% |
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 multiplan.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 MultiPlan pattern means for provider groups
For disputes answered from multiplan.com, providers' 79.6% offer-selection rate was 7.5 percentage points below the 87.1% rate across all other response domains. Yet the median prevailing offer was higher, at 423% of QPA versus 395%, while defaults were more common at 3.6% versus 2.3%. Because MultiPlan acts as an administrator or repricer and the entered plan names most often identify Cigna, these figures describe the responding-domain workflow, not a single underlying insurance product.
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 MultiPlan
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