Anatomy of a Dispute: The Specialty Split

Providers win most federal IDR disputes. Of 5.7 million line items in the 2025 public data, 85.6 percent were decided in favor of the provider or facility. But that average hides a split that matters enormously if you are the one filing.

Radiology: 94.1 percent provider win rate (890,034 line items).
Anesthesiology: 80.8 percent provider win rate (59,567 line items).

That is a 13.3-point gap between two specialties playing the same game under the same statute. Emergency medicine sits at 84.7 percent. Anesthesia at 82.5 percent. Emergency room services at 82.1 percent. The spread is real, persistent across hundreds of thousands of records, and it has nothing to do with the law. The No Surprises Act does not grade specialties on a curve.

Why the same playbook produces different results

A radiology dispute and an anesthesia dispute look nothing alike under the hood. Different service codes. Different QPA dynamics. Different clinical documentation. Different arbitrator expectations for what good evidence means. A high-performing radiology practice wins because its evidence packages speak radiology: the right codes, the right comparables, the right documentation of complexity.

Now hand that same generic evidence template to an anesthesia group. The codes are different. The QPA benchmarks behave differently. The clinical narrative that persuades for imaging falls flat for time-based anesthesia services. The result is predictable: 13 points of win rate left on the table, not because the cases are weaker, but because the evidence was built for someone else's specialty.

This is the quiet failure mode of template filing. One evidence package, applied across specialties, service codes, and QPA contexts, performs like an average. And the average conceals that you are winning the easy ones and donating the hard ones.

What the winners do differently

The high-win-rate filers do not have better lawyers. They have better inputs. Every evidence package is built for the specialty, the service code, and the QPA context of that specific dispute: patient acuity, teaching status, market share, prior contracted rates. The four factors the statute actually cares about, documented with sources, sealed, and signed off by a human reviewer who knows what an arbitrator looks for in that specialty.

That is not a template. It is a per-dispute evidence record. And it is the difference between 94 percent and 81 percent.

The takeaway

The dispute is not generic. The evidence cannot be either. If your filing operation uses one package for every specialty, the public data says you are funding someone else's win rate. Specialty-specific, source-traced evidence for every dispute is not a luxury. It is the entire game.