What the Federal Medians Say Your Claims Are Worth
Three inputs from you. Every other number is published by the Departments, named on this page, and linked to the source. The formula is printed under the result so you can check the arithmetic rather than trust it.
Calculator
The arithmetic: claims × 12 × providers × 81% reaching a decision × 85% decided for providers × your QPA × (multiple − 1). The three fixed factors are published CMS figures for 2025 — sources here. This is a scenario built from federal medians, not a prediction: your eligibility, timing, documentation and payer mix move every number in it. The result is gross, before our contingency percentage and before the certified IDR entity fee on disputes that do not prevail — what this costs.
The Multiple Falls As the Claim Grows
| QPA range | Median prevailing offer vs QPA | Determinations, H2 2025 |
|---|---|---|
| <$100 | 5.22× | 260,840 |
| $100 - $500 | 3.71× | 678,771 |
| $500 - $1,000 | 3.12× | 160,801 |
| $1,000 - $5,000 | 2.62× | 162,394 |
| $5,000 - 10,000 | 2.3× | 15,977 |
| ≥$10,000 | 1.69× | 22,966 |
The claims most practices write off as too small to argue about are, by the published medians, the ones where the plan's benchmark sat furthest from what an independent entity found defensible. That calculation changed again in June 2026, when the administrative fee dropped from $115 to $15 per party per dispute. What batching does to this arithmetic.
Straight Answers About This Tool
What exactly is this calculating?
The gap between what a plan paid and what the median prevailing offer was in comparable federal IDR determinations — annualised, and reduced by the published rates at which disputes reach a decision and go to the provider side. It is a scenario built from federal medians, not a prediction about your claims.
Where do the numbers come from?
CMS publishes them. The specialty multiples are Table 14 of the Federal IDR supplemental tables for Q4 2025; the claim-size multiples are Table 13; the 85% figure is Table 12. The eligibility factor comes from the Departments' reporting that about 19% of disputes initiated in 2025 were found ineligible.
Why do the two answers differ?
Because they are different cuts of the same determinations. Specialty and claim size both move the multiple, and CMS does not publish them crossed. If your claim sizes are typical for your specialty the two answers converge; if they are not, the claim-size figure is usually the better guide.
Does a high multiple mean I will win?
No. The multiple describes how far the prevailing offer sat above the plan's benchmark in disputes that reached a decision. It says nothing about whether a particular claim is eligible, filed in time, or documented well enough — and eligibility is where roughly one dispute in five ends.
What does the process itself cost?
An administrative fee of $15 per party per dispute for disputes initiated on or after 11 June 2026, and the certified IDR entity's fee, which the non-prevailing party pays. Our own fee is a percentage of what is actually recovered. All of it is set out on the pricing page.