Claim Setup
Post-Ruling Statutory Factors (Non-QPA)
Provider Training / Acuity Level
Market Share / Network Power
Teaching / Safety Net Status
Good Faith Contracting Efforts
Arbitration Benchmark Comparison
Voided QPA Anchor vs Revised Multi-factor
Patient Cost-Share Cap
$240.00
Provider Post-Ruling Win %
68%
Projected IDR Award
$3,200.00
Insurer Financial Delta
+$2,000.00
IDR Statutory Dispute Brief & Audit Findings
Under the vacated HHS QPA methodology, arbitrator benchmark strictly favored the insurer QPA of $1,200. Following the US Appeals Court ruling, statutory multi-factor evaluation shifts the primary benchmark toward $2,430, elevating provider offer viability. Patient out-of-pocket remains capped by statute based on standard in-network cost-sharing.
IDR Benchmark Outcome: Provider Offer Favored (Post-Ruling Statutory Framework)