Federal IDR outcomes in Maine
In 2025 Q1–Q4, the provider or facility offer prevailed in 91.7% of 2,333 determined Federal IDR dispute line items for services provided in Maine. The median prevailing offer was 2.93x the QPA (25th–75th percentile 2.39x–3.37x; n = 2,179). The median time to a decision was 30 business days (n = 2,333).
Determined line items
2,333
2025 Q1–Q4 · 0 split decisions excluded
Provider win rate
91.7%
n = 2,333 · 2025 Q1–Q4
Median payment vs QPA
2.93x
middle half 2.39x–3.37x · n = 2,179 · 2025 Q1–Q4
Median days to decision
30
business days, from dispute initiation · n = 2,333 · 2025 Q1–Q4
Dollar amounts
Total awarded
$958,788
sum of prevailing offers · n = 1,727 · 2025 Q1–Q4
Total QPA
$361,301
sum of QPAs, same line items · n = 1,727 · 2025 Q1–Q4
Awarded above QPA
$597,487
total awarded minus total QPA · n = 1,727 · 2025 Q1–Q4
Median award per line item
$505
mean $555 · n = 1,727 · 2025 Q1–Q4
Median QPA
$184
per line item · n = 1,727 · 2025 Q1–Q4
Award vs QPA, dollar-weighted
2.65x
total awarded ÷ total QPA · n = 1,727 · 2025 Q1–Q4
Dollar amounts come from the separate CMS “QPA and Offers” file: line items decided for the provider or the plan with a non-suppressed QPA and prevailing offer. That file cannot be joined to the line items above, so its n differs. Awarded = the prevailing (selected) offer; it is not a record of what was paid. State comes from the file’s geographic region; a metro area that spans states counts in each. How the dollar figures work
Dollar amounts by period
| Period | Line items with $ | Total awarded | Total QPA | Above QPA | Median award | Median QPA | Award ×QPA ($-weighted) |
|---|---|---|---|---|---|---|---|
| 2025 Q1–Q4 | 1,727 | $958,788 | $361,301 | $597,487 | $505 | $184 | 2.65x |
| 2024 Q3–Q4 | 652 | $401,225 | $196,348 | $204,878 | $481 | $246 | 2.04x |
| 2024 Q3–2025 Q4 | 2,379 | $1.4M | $557,649 | $802,364 | $505 | $189 | 2.44x |
| 2023 Q1–2024 Q2 | Not available (see methodology). | ||||||
From the CMS QPA and Offers file (see above). Award ×QPA here is total awarded ÷ total QPA, so large claims weigh more than in the per-line median ratio.
By period
| Period | Line items | Win % | Median ×QPA | 25th–75th | Ratio n | Median days |
|---|---|---|---|---|---|---|
| 2025 Q1–Q4 | 2,333 | 91.7% | 2.93x | 2.39x–3.37x | 2,179 | 30 |
| 2024 Q1–Q4 | 843 | 62.9% | 1.78x | 1.00x–3.06x | 829 | 228 |
| 2023 Q1–Q4 | 61 | 45.9% | 1.00x | 1.00x–3.06x | 59 | 50 |
| 2023 Q1–2025 Q4 | 3,237 | 83.3% | 2.85x | 1.75x–3.30x | 3,067 | not 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.
By specialty in Maine
| Specialty group | Line items | Win % | Median ×QPA | Ratio n | Median days |
|---|---|---|---|---|---|
| Emergency medicine and emergency departments | 1,746 | 93.8% | 2.98x | 1,735 | 27 |
| Neonatology | 352 | 86.1% | 1.65x | 331 | 57 |
| Intraoperative neuromonitoring | 138 | 92.0% | 21.28x † | 73 | 29 |
| Orthopedic surgery | 50 | 84.0% | – | 2 | 39.5 |
2025 Q1–Q4 · rows with n ≥ 30 determined line items · sorted by n.
Most disputed CPT codes in Maine
| CPT code | Line items | Win % | Median ×QPA | Ratio n | Median days |
|---|---|---|---|---|---|
| 99284 Emergency department visit with moderate level of medical decision making | 816 | 93.3% | 2.94x | 812 | 27 |
| 99285 Emergency department visit with high level of medical decision making | 584 | 94.5% | 2.93x | 579 | 27 |
| 99283 Emergency department visit with low level of medical decision making | 325 | 93.8% | 3.37x | 322 | 24 |
| 99479 Follow-up intensive care of recovering low birth weight infant per day | 134 | 66.4% | 1.49x | 134 | 57 |
| 99480 Follow-up intensive care of recovering medium birth weight infant per day | 76 | 100.0% | 1.47x | 71 | 62 |
| 99469 Follow-up inpatient hospital critical care of newborn per day (28 days or younge | 72 | 94.4% | 1.62x | 56 | 167 |
| 99472 Follow-up inpatient hospital critical care of infant or young child per day (29 | 62 | 100.0% | 2.39x | 62 | 47 |
| 95938 Placement of skin electrodes and measurement of stimulated sites on arms and leg | 36 | 88.9% | – | 21 | 30 |
| 95955 Measurement of brain wave activity (EEG) outside the brain during surgery | 30 | 83.3% | – | 17 | 29.5 |
2025 Q1–Q4 · rows with n ≥ 30 determined line items · sorted by n.
Payers with the most determined line items in Maine
Payer = health plan/issuer email domain reported by CMS, with the most common plan name for that domain. Some domains belong to vendors acting for plans.
| Payer (email domain) | Line items | Win % | Median ×QPA | Ratio n | Median days |
|---|---|---|---|---|---|
| ANTHEM BLUE CROSS BLUE SHIELD (anthem.com) | 1,086 | 94.4% | 3.20x | 1,004 | 30 |
| AETNA (aetna.com) | 443 | 91.9% | 2.98x | 434 | 19 |
| UNITED HEALTHCARE (uhc.com) | 426 | 87.6% | 2.24x | 413 | 52 |
| UMR (clearhealthcloud.com) | 187 | 80.7% | 2.51x | 186 | 28 |
| UMR (clearhs.com) | 97 | 100.0% | 2.26x | 81 | 35 |
2025 Q1–Q4 · rows with n ≥ 30 determined line items · sorted by n.
Dollar amounts by CPT code in Maine
| CPT code | Line items with $ | Total awarded | Median award | Median QPA | Award ×QPA |
|---|---|---|---|---|---|
| 99284 Emergency department visit with moderate level of medical decision making | 690 | $334,912 | $505 | $165 | 2.88x |
| 99285 Emergency department visit with high level of medical decision making | 523 | $355,289 | $681 | $227 | 3.02x |
| 99283 Emergency department visit with low level of medical decision making | 288 | $96,089 | $344 | $87 | 3.55x |
| 99479 Follow-up intensive care of recovering low birth weight infant per day | 86 | $31,297 | $400 | $290 | 1.32x |
| 99480 Follow-up intensive care of recovering medium birth weight infant per day | 65 | $28,992 | $450 | $284 | 1.73x |
| 99472 Follow-up inpatient hospital critical care of infant or young child per day (29 | 40 | $61,000 | $1,500 | $670 | 2.28x |
| 99469 Follow-up inpatient hospital critical care of newborn per day (28 days or younge | 35 | $51,208 | $1,500 | $966 | 1.56x |
2025 Q1–Q4 · CMS QPA and Offers file · rows with n ≥ 30 line items with dollar amounts · sorted by n · Award ×QPA = total awarded ÷ total QPA.
FAQ
What is the Federal IDR provider win rate for services provided in Maine?
In 2025 Q1–Q4, the provider or facility offer was selected in 91.7% of 2,333 determined dispute line items for services provided in Maine. 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 services provided in Maine?
In 2025 Q1–Q4, the median prevailing offer was 2.93x the qualifying payment amount (QPA), with a 25th to 75th percentile range of 2.39x to 3.37x (n = 2,179 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 services provided in Maine?
In 2025 Q1–Q4, the median was 30 business days (n = 2,333 line items), using the CMS field Length of Time to Make Determination (from dispute initiation).
Maine figures count line items whose place of service was Maine. See methodology for caveats.