IDRDesk

Is this claim worth disputing?

An estimate per item using published CMS medians and win rates, less the administrative fee, the entity fee you pay if you lose, and your own time.

Not legal advice. Estimates only, based on published rules and CMS aggregates. Do not enter patient names or other identifiers. The numbers and dates you enter in this tool stay in your browser and are not sent to us.

Regulatory range: $200 to $840 for a single determination, $268 to $1,173 for a batch, plus $75 to $250 per additional 25 line items. The entity returns the prevailing party's fee, so in effect the loser pays.

$15 per party per dispute for disputes initiated on or after June 11, 2026 (45 CFR 149.510(d)(2)).

Your estimate will appear here.

How to read this

The calculator multiplies the QPA by the median prevailing offer for the specialty (or QPA band) to estimate a typical provider offer, then weights it by the win rate. If the plan prevails it assumes payment of about the QPA. Real outcomes vary widely: the 90th percentile of awards is far above the median.

See the benchmarks for the data behind the defaults.

Track disputes without a spreadsheet

We are building a flat-fee tracker for eligibility, deadlines, batches and payment follow-up. Join the list and we will email you when it opens. No patient information needed.