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Who files Federal IDR disputes?
In 2025-Q4 the ten largest initiating parties or their representatives filed 67% of out-of-network emergency and non-emergency disputes. Practices with 50 or fewer employees were behind 37% of initiations.
Top initiating parties or their representatives
CMS lists the party or representative that submitted the dispute, which can be a billing company filing for many practices.
| Party or representative | Disputes initiated | Share |
|---|---|---|
| HaloMD | 134,467 | 19% |
| Team Health | 75,762 | 11% |
| SCP Health | 50,451 | 7% |
| F&A Management | 39,683 | 6% |
| Radiology Partners | 36,312 | 5% |
| M&D Capital Advisors | 35,718 | 5% |
| QMACS, Inc. | 32,493 | 5% |
| Radix | 32,329 | 5% |
| US Anesthesia Partners | 17,174 | 2% |
| Gottlieb & Greenspan | 16,852 | 2% |
By practice or facility size
| Size | 2025-Q1 | 2025-Q2 | 2025-Q3 | 2025-Q4 |
|---|---|---|---|---|
| Fewer than 20 Employees | 41,858 | 47,345 | 62,285 | 77,900 |
| 20-50 Employees | 160,032 | 213,156 | 231,204 | 184,975 |
| 51-100 Employees | 65,399 | 67,244 | 68,649 | 68,454 |
| 101-500 Employees | 122,649 | 110,393 | 107,964 | 107,506 |
| Over 500 Employees | 53,152 | 54,816 | 58,462 | 95,820 |
| Unknown | 91,082 | 137,876 | 115,106 | 172,846 |
Source: CMS Federal IDR Supplemental Tables, reporting year 2025 (CMS reports page). Quarterly medians cannot be combined into a yearly median, so each quarter is shown separately.
Many small practices appear to use a representative. Our fee calculator shows what a percentage arrangement costs against a flat fee.