Which Arbitrator Did Your IDR Dispute Draw?
The federal IDR public use files started naming the certified IDR entity behind every determination this summer. Run the Q4 2025 file and the provider win rate goes from 98.2% at one entity to 56.1% at another, and it holds on a single ED visit code across two quarters. The entity-selection form moves into the IDR Gateway on November 13.
You do not pick who decides your out-of-network disputes, and for three and a half years the government's own file would not tell you who had.
That ended quietly in July. The Departments put a note at the top of the IDR reports page: beginning with the files covering the back half of 2025, "each dispute line item in the PUF now includes the name of the certified IDR entity that conducted the payment determination."
Fifteen entities closed 532,542 disputes in the fourth quarter of 2025. Run the line-item file against them and the provider win rate goes from 98.2% at the top of the roster to 56.1% at the bottom.
So the obvious objection first: different entities draw different work, and emergency physicians, radiology groups and anesthesia all file at different rates. Hold the service code constant and the spread survives anyway (chart below). On CPT 99284 alone, the single highest-volume code in the file at 230,478 line items, providers won 96.5% at Island Peer Review Organization and 57.0% at Medical Evaluators of Texas.
Same code. Same quarter. Thirty-nine points.
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