IDR Data
CMS PUF data · 2023 Q1–2025 Q4

Federal IDR outcomes: Hospitals and facilities in Illinois

In 2025 Q1–Q4, the provider or facility offer prevailed in 67.7% of 257 determined Federal IDR dispute line items for hospitals and facilities in Illinois. The median prevailing offer was 1.41x the QPA (25th–75th percentile 1.00x–3.57x; n = 213). The median time to a decision was 25 business days (n = 257).

Determined line items

257

2025 Q1–Q4 · 0 split decisions excluded

Provider win rate

67.7%

n = 257 · 2025 Q1–Q4

Median payment vs QPA

1.41x

middle half 1.00x–3.57x · n = 213 · 2025 Q1–Q4

Median days to decision

25

business days, from dispute initiation · n = 257 · 2025 Q1–Q4

Dollar amounts are not shown for specialty groups: the CMS QPA and Offers file, the only source of dollar figures, has no specialty field. See methodology.

By period

PeriodLine itemsWin %Median ×QPA25th–75thRatio nMedian days
2025 Q1–Q425767.7%1.41x1.00x–3.57x21325
2024 Q1–Q46296.8%1.00x1.00x–1.00x6237
2023 Q1–Q43562.9%1.37x1.00x–2.43x3174
2023 Q1–2025 Q435472.3%1.00x1.00x–2.47x306not pooled

Line items = determined dispute line items (n). Win rate excludes split decisions and includes default decisions. Ratio n = line items reporting a payment-to-QPA ratio. Days are business days as reported by CMS (2023–2024: from IDR entity assignment; 2025: from initiation) and are never pooled.

Most disputed CPT codes

No row has 30 or more determined line items in 2025 Q1–Q4.

Related: all specialties in Illinois · Hospitals and facilities in all states

FAQ

What is the Federal IDR provider win rate for hospitals and facilities in Illinois?

In 2025 Q1–Q4, the provider or facility offer was selected in 67.7% of 257 determined dispute line items for hospitals and facilities in Illinois. Split decisions are excluded from the denominator and default decisions are included. Withdrawn, settled and ineligible disputes are not in the CMS data.

How do Federal IDR payments compare with the QPA for hospitals and facilities in Illinois?

In 2025 Q1–Q4, the median prevailing offer was 1.41x the qualifying payment amount (QPA), with a 25th to 75th percentile range of 1.00x to 3.57x (n = 213 line items). This uses the CMS field Prevailing Party Offer as % of QPA, where 1.00x equals the QPA.

How long do Federal IDR decisions take for hospitals and facilities in Illinois?

In 2025 Q1–Q4, the median was 25 business days (n = 257 line items), using the CMS field Length of Time to Make Determination (from dispute initiation).

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