Your disputed claims
Amounts are the total allowed amount for the service. Use a service label only — no patient names or account numbers. Leave the offer blank to have the tool find the best one.
Fees and assumptions
Fees change over time: take the current administrative and IDR entity fees from the federal IDR portal. The model has the losing side bear the entity fee and both sides pay the administrative fee. The win chances are your estimate from your own past outcomes, not a published statistic.
Add your claims, then click Calculate.
Calibrate the win chances from your own past disputes
Guessing "85% at the QPA, 25% at billed" is the weakest input. If you have closed IDR disputes, paste them here: one per line, label, billed charge, QPA, the offer you submitted, won or lost. The tool fits a win-chance curve to your results (pulled toward your current assumption when you have few) and fills the two win-chance boxes above. Same service labels only, no patient details.
Paste past results, then fit. Nothing is uploaded and nothing is applied until you click Fit.
Result
By claim
| Claim | Billed | QPA | Paid | Offer used | % of QPA | Win chance | Expected net | Break-even win | Decision |
|---|
How much rides on your win-chance assumption
| Both win chances shifted | Win chance at QPA | Claims worth filing | Total expected net |
|---|
Deadline helper
Enter the date of the initial payment or denial.
How it is calculated
Payer offer: the larger of the amount already paid and the QPA × your expected payer offer. Win chance: flat at your QPA figure up to the QPA, then falling in a straight line to your billed-charge figure at the billed charge. Expected net: (payer offer − paid) + win chance × (your offer − payer offer) − administrative fee − (1 − win chance) × entity fee − staff time, with fees divided by the claims sharing the dispute. Break-even win chance: the win chance at which that expected net is zero for the offer used. Best offer: the offer between the QPA and the billed charge with the highest expected net. Deadlines: 30 business days from the date you enter, then 4 business days, skipping weekends and the holidays you list.
Not modelled: the arbitrator's actual decision factors (such as acuity, market share and prior contracts), the exact fee schedule, batching eligibility, patient cost-sharing, appeals, and what a payer does after a loss. Unverified: tested on hand-calculated examples, not on real IDR outcomes. It computes arithmetic; it does not tell you what the arbitrator will decide or what to offer.
Common questions
Should I take a No Surprises Act claim to federal IDR?
It depends on the gap and the fees. Compare the extra money a win brings, the payer's likely offer, the administrative fee you pay either way and the IDR entity fee you risk on a loss. The tool computes the expected net for each claim from your own win-chance assumptions and shows the win chance you need to break even.
How do I pick an offer amount for the arbitrator?
The arbiter picks one of the two offers, so a higher ask earns more if it wins and wins less often. The tool draws a straight line from your win chance at the QPA to your win chance at the billed charge, tries every offer in between, and shows the one with the best expected net. The line is your assumption, not a prediction, so check how the answer moves in the sensitivity table.
What is the qualifying payment amount (QPA)?
The QPA is the payer's calculation of the median contracted rate for the same or a similar service in the same area, and it is where the arbitrator starts. The payer reports it; the tool takes the figure you type and does not calculate it.
Can I batch claims into one dispute?
Batching lets several claims share fees, which can turn small claims from not worth filing into worth filing. The rules limit what can be batched, so enter the number of claims you expect to share a dispute and check the current federal rules for what qualifies.
When do I have to start the IDR process?
Open negotiation runs for 30 business days from the initial payment or denial, and an IDR request is generally due within 4 business days after that. The deadline helper counts weekdays and skips the holidays you list. Verify the dates against the current federal guidance before you rely on them.
What fees does the tool use?
None of its own. The administrative fee and the IDR entity fee change over time and by dispute type, so you enter the current figures from the federal IDR portal. With both left at zero the tool warns you that every claim will look worth filing.
Is my information uploaded?
No. The calculation runs in your browser from figures you type, nothing is sent to a server, there are no accounts, and it works offline after the page loads. No patient information is needed or accepted: use a label such as a service type, not a name or account number.