A formal path to challenge underpayments
For qualifying out-of-network claims, Federal IDR gives providers a structured way to contest a plan’s payment after open negotiation does not resolve the dispute.
Federal independent dispute resolution
The No Surprises Act.
A path to fairer payment.
For qualifying out-of-network claims, the law gives providers a defined process to challenge underpayments—and national data shows why disciplined participation matters.
THE NATIONAL RECORD
Providers are using Federal IDR—and often prevailing.
These figures come from the national market statistics cited in Astra’s September 2026 presentation. They describe industry-wide outcomes, not Astra’s own performance or a forecast for any claim.
Provider win rate85%
Share of 2025 Federal IDR disputes reported as decided in the provider’s favor.
Median award vs. QPA445%
Median payment determination relative to the payer’s benchmark when a physician prevailed.
H2 2025 determinations1.14M+
Disputes closed with a payment determination in six months—far above the roughly 17,000 annual disputes projected before launch.
What this means for providers
The law creates leverage. The process determines whether you keep it.
Federal IDR can help providers pursue payment beyond the amount set by the plan, but eligibility rules, short deadlines, and case-specific submissions make execution essential.
A decision beyond the payer’s benchmark
The certified IDR entity considers the QPA alongside permitted case-specific information, giving providers room to explain why their offer is the more reasonable amount.
Meaningful revenue can be recoverable
The presentation reports a 445% median award relative to QPA when physicians prevailed in 2025—a national result that shows why eligible claims merit careful review.
A repeatable process can work at scale
More than 1.14 million disputes reached payment determinations in the second half of 2025 alone. Screening, batching, filing, and deadline control turn that opportunity into an operation.
SOURCES & CONTEXT
National statistics, responsibly presented.
The presentation cites CMS Federal IDR Public Use Files for the second half of 2025 and Georgetown University Center on Health Insurance Reforms analyses of 2025 Federal IDR data. Results vary by claim, specialty, market, eligibility, evidence, offer strategy, and procedural compliance.
Review CMS Federal IDR reports