Turquoise Health has launched a new dashboard that provides free tracking of independent dispute resolution (IDR) awards from disputes over services covered by the No Surprises Act. Although the Centers for Medicare & Medicaid Services posts public quarterly award results, the data is contained in excessively large and complex files. In contrast, Turquoise’s tool shows IDR award data for the Current Procedural Terminology (CPT) code for 1,670 types of services. The tool further details not only national data, but data for each state and metropolitan statistical area.
The Turquoise dashboard will provide employers, insurers, providers, and other stakeholders with concrete and easily accessible data. These groups are likely to use this data to argue for changes to the IDR system in Congress.
According to data compiled in the Turquoise tool, IDR services decided 225,795 cases in the second quarter of 2025 involving physicians’ billings for emergency department visits with a “moderate level of medical decision making.” In those cases, IDR services ruled in favor of the medical providers over 85% of the time, with a median award of $795. This figure is much greater than the median amount that commercial insurers pay for the same service in the same markets, which is $140. Based on this data, IDR awards increased commercial insurers’ costs in these cases by an aggregate of $637 million.
The data show similar results for ER visits with low levels of medical decision-making. In those cases, medical providers prevailed in over 87% of the 18,282 reported IDR cases. The median award was $2,769, compared with the median in-network market rate of $738. These awards thus increased the commercial insurers’ costs by $420 million.
Differences between the market rate for services and the IDR award rate were even greater in cases involving hospital charges for one hour of patient observation. In these 454 cases, IDR services found in favor of the hospitals over 86% of the time. While the median in-network rate for that service was $86, the median award was $19,985, thereby adding about $11 million to commercial insurers’ costs.
Congress passed the No Surprises Act to protect patients with commercial insurance from receiving an unexpected balance or surprise bills for out-of-network care. The Act covers situations in which patients receive emergency care in out-of-network hospitals, unknowingly receive care from out-of-network providers in in-network hospitals, and utilize air ambulance services. If providers and insurers, or self-insured employer plans, cannot agree on the amount of payment for these services, the disputes are supposed to go to IDR services for resolution rather than billing patients.
Employer and insurer groups have long argued that the IDR system favors medical providers, which seems borne out by the Turquoise dashboard data. As a result, health plans are advocating reforms to the IDR system to address unfair provider costs that raise healthcare expenses for everyone.
On the other hand, emergency room physicians have reported in online forums that collecting awards from the IDR system is challenging. Medical services management firms handle much of the billing process without input from physicians. They also claim that private-equity-owned medical practices file and win most IDR claim disputes, rather than small and mid-size medical practices.
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