For Providers, IDR May Turn Claims Into Recovery

Providers who may have been underpaid on out-of-network private payor claims have a real avenue for recovery using the Independent Dispute Resolution (IDR) process established by the No Surprises Act (NSA). A recent analysis released by Georgetown University's Center on Health Insurance Reforms concluded that when providers use the IDR process, they tend to win.

The researchers found that in 2025, providers prevailed in approximately 85% of all disputes. The NSA uses the qualifying payment amount (QPA) as a key reference point in the IDR process. QPA is the median contracted rate that a health plan or insurer recognizes for the same or similar item or service provided by a provider in the same or similar specialty and geographic region, measured as of January 31, 2019, and adjusted annually for inflation. The study's data shows that providers receive substantial recovery compared with QPA.

Median Provider Award as Percentage of QPA

The analysis reported particularly significant recoveries across several specialties, with median provider awards well above QPA in 2025:

Provider Awards in Context of IDR Costs

It is worth underscoring the provider awards because the same study emphasizes that the IDR process has cost $22.4 billion since its launch, including payment amounts awarded by IDR entities, administrative costs, and fees. Payor and employer groups have cited those figures as evidence that the system is broken. But a closer look at the same data tells a different story: The increase in IDR activity suggests that the dispute-resolution mechanism established by the NSA is being widely utilized to challenge disputed payment amounts. The rising IDR costs are, in significant part, a function of more providers filing claims that succeed on the merits, not defects in the IDR system requiring correction.

In light of the August 2026 report, providers ought to revisit whether they are fully using the IDR process available to them. As discussed in our June alert on the Final Rule updating the IDR process, the Health and Human Services, Labor, and Treasury Departments cut the administrative fee to initiate a dispute from $115 to $15 per party, for disputes filed on or after June 11, 2026. Underpayments that were once too small to justify the costs of arbitration may now be worth pursuing. Expanded batching rules also add to that opportunity by allowing disputes to be grouped by patient encounter. This allows providers with recurring underpayment patterns to pursue recovery more efficiently without the administrative burden of filing claims individually.

Criticism of the IDR process overlooks a plausible alternative explanation: Providers are bringing well-documented claims, and arbitrators are applying the statutory factors as written. A high provider success rate may reflect the merit of the underlying claims being brought by providers. The IDR process serves as a neutral dispute-resolution mechanism by giving out-of-network providers an avenue to challenge legitimately underpaid claims, regardless of specialty, and by producing awards that more accurately reflect the value of services than payor-set reimbursement rates.

Key Takeaways for Providers

Recent developments in the IDR process may create meaningful new opportunities for providers seeking recovery on out-of-network claims. Reports on successful IDR outcomes emphasize the importance of evaluating whether underpaid claims are appropriate for arbitration.

Providers should consider reviewing both individual underpaid claims and recurring reimbursement patterns to determine whether IDR may offer a cost-effective recovery path. In particular, providers experiencing repeated reimbursement reductions involving the same services, payors, or patient encounters may benefit from reassessing whether a revised IDR strategy could improve recovery efforts and reduce ongoing underpayments.

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Christine Parkins Johnson is counsel in DWT's Los Angeles office and Rawan Khalili is an associate in the firm's San Francisco office. For questions or more insights, please reach out to Christine, Rawan, or another member of our healthcare team and sign up for our alerts.