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The qualifying payment amount (QPA) is calculated by the health plan as generally the median contracted rate for the same or similar item or service in the geographic region. If the plan disclosed it, enter it. All fields accept dollars and cents.
Your position
Published benchmarks used here
- 3.9x QPA: median payment determination ran about 3.9 times the QPA in published analyses of CMS data (Paragon Health Institute).
- 88%: providers won about 88% of payment determinations in the first half of 2025 (Becker's, citing CMS data).
- 87%: the prevailing offer exceeded the QPA in about 87% of second-half 2025 determinations.
Benchmarks describe the past. They do not predict any individual determination, which turns on the facts, the parties, the record, and the certified IDR entity.
Numbers are only half the filing
The other half is the evidence record: permitted-factor proof, source traceability, and a packet your reviewer can defend. Start with a free one-page IDR Scorecard from your public CMS history.
Compare your offer against the qualifying payment amount and published federal IDR benchmarks. Free informational tool by AI Tech Pros.
Estimates only, not legal advice. QPAs are payer-calculated; the certified IDR entity makes the payment determination.