Federal IDR Uses Baseball Arbitration — Here Is Why That Matters for Non-Par Providers

Federal IDR uses baseball arbitration. Both sides submit a number. The arbitrator picks one.

Not a compromise. Not a split. One number wins. One number loses.

This is critical because it prevents insurance companies from lowballing and meeting in the middle. If their number is unreasonably low and yours is well-supported — the arbitrator picks yours.

Provider win rate: 85-88% on federal IDR. Higher on state.

The Submission Is Everything

The trick is the submission. Your number needs to be supported — Fair Health data, complexity factors, geographic benchmarks, everything documented. The insurance company submits QPA and a few paragraphs.

We submit a package. Every claim. Every factor. Signed by an attorney.

That is why the win rates are what they are.

Why This Matters for Your Practice

If you are an out-of-network provider sitting on underpaid claims and not filing IDR — you are leaving money on the table. The arbitration mechanism exists. The win rates are public. The process is straightforward if you know how to build a submission.

I personally sign every IDR submission. Fordham Law. Law Review. Clifford Chance. Nearly twenty years in non-par claims. When the arbitrator opens our package, it is attorney work product — not a billing department template.

Eliott Dear, Esq. | NY Bar #4329546
646-387-9133 | edear@edrtb.com
claims-assassins.com

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