{
  "dataset": "Federal IDR process, second half of 2025",
  "period": {
    "start": "2025-07-01",
    "end": "2025-12-31",
    "label": "H2 2025"
  },
  "source": {
    "publisher": "U.S. Departments of Health and Human Services, Labor, and the Treasury",
    "document": "Supplemental Background on Federal Independent Dispute Resolution Public Use Files, July 1, 2025 – December 31, 2025, and the accompanying Federal IDR Supplemental Tables for 2025 Q3 and 2025 Q4",
    "sourceFormat": "XLSX",
    "sourceUpdated": "2026-07-22",
    "sourceUrl": "https://www.cms.gov/initiatives/no-surprise-billing/overview/policies-resources/independent-dispute-resolution-reports",
    "note": "Figures are transcribed from the published federal tables. Nothing here is estimated, modelled or adjusted. Where a value is a sum of the two quarters, the field name says so."
  },
  "disputes": {
    "initiated": 1372563,
    "initiatedByProvidersAndPractices": 1049137,
    "initiatedByFacilities": 323249,
    "initiatedByPlansAndIssuers": 177,
    "closed": 1449900,
    "eligibilityChallengedByNonInitiatingParty": 574128
  },
  "closureReasons": [
    {
      "reason": "Payment determination issued",
      "disputes": 1145039
    },
    {
      "reason": "Found ineligible",
      "disputes": 271399
    },
    {
      "reason": "Other",
      "disputes": 33462
    }
  ],
  "outcomes": {
    "paymentDeterminations": 1145039,
    "prevailingProviderFacilityOrAirAmbulance": 977661,
    "prevailingPlanOrIssuer": 165982,
    "splitDecisions": 1384,
    "prevailingOfferAboveQpa": 995270,
    "determinationsWhereOnlyOnePartySubmittedAnOfferAndPaidFees": 189868,
    "reportedShares": {
      "note": "Percentages as stated in the Departments' report text, which rounds.",
      "providerPrevailedPct": 85,
      "planPrevailedPct": 14,
      "prevailingOfferAboveQpaPct": 87,
      "defaultDecisionsPct": 17,
      "defaultDecisionsFavouringProviderPct": 90,
      "nonDefaultProviderWinPct": 84
    }
  },
  "planTypeOfInitiatedDisputes": [
    {
      "planType": "Either partially or fully self-insured private (employment-based) group health plan",
      "disputes": 936930
    },
    {
      "planType": "Fully insured private group health plan",
      "disputes": 181413
    },
    {
      "planType": "Individual health insurance issuer",
      "disputes": 87472
    },
    {
      "planType": "Federal Employees Health Benefits (FEHB) Carrier",
      "disputes": 29771
    },
    {
      "planType": "Non-federal government plan (or state or local government plan)",
      "disputes": 100271
    },
    {
      "planType": "Church Plan",
      "disputes": 976
    },
    {
      "planType": "No Issuer Response",
      "disputes": 35730
    }
  ],
  "initiatingPartySize": [
    {
      "size": "Fewer than 20",
      "disputes": 140185
    },
    {
      "size": "20 to 50",
      "disputes": 416179
    },
    {
      "size": "51 to 100",
      "disputes": 137103
    },
    {
      "size": "101 to 500",
      "disputes": 215470
    },
    {
      "size": "More than 500",
      "disputes": 154282
    },
    {
      "size": "Unknown",
      "disputes": 287952
    }
  ],
  "expenditures": {
    "currency": "USD",
    "administrativeFeesCollected": 282966495,
    "certifiedIdrEntityCompensation": 649746436,
    "federalExpenditures": 29459467
  },
  "priorPeriodForComparison": {
    "period": {
      "start": "2025-01-01",
      "end": "2025-06-30",
      "label": "H1 2025"
    },
    "initiated": 1186812,
    "closed": 1349343,
    "paymentDeterminations": 1082247,
    "providerPrevailedPct": 88,
    "defaultDecisionsPct": 22,
    "nonDefaultProviderWinPct": 87
  }
}