New CMS data shows Claritev led all non-payer organizations in federal IDR volume while delivering outcomes above industry averages
- Claritev achieved a 20% IDR success rate versus 12% industrywide, increasing to 24% versus 15% in the fourth quarter
- Claritev ranked as the market-leading independent non-payer IDR administrator, with volumes exceeded only by the nation’s largest health insurers
MCLEAN, Va.--(BUSINESS WIRE)--$CTEV #HealthcareAffordability--Claritev Corporation (NYSE: CTEV), a healthcare technology, data, and insights company focused on making healthcare more affordable, transparent and fair for all, today announced that, according to newly released 2025 data from the Centers for Medicare & Medicaid Services (CMS), the Company handled more federal Independent Dispute Resolution (IDR) claims than any other non-payer participant.
Claritev was the leading independent IDR administrator among all non-payer organizations by volume, underscoring its ability to support clients at national scale. Claritev’s broader claims intelligence, contracted network of 1.4 million providers, and financial negotiation capabilities also help clients address eligible claims earlier, reducing the number of disputes that proceed to federal IDR. By helping clients address claims earlier and resolve disputes efficiently when they arise, Claritev supports the No Surprises Act’s central goal of protecting patients from unexpected bills and keeping them out of payment disputes.
The No Surprises Act was designed to protect insured patients from certain unexpected out-of-network bills and limit their cost-sharing responsibility. It established the IDR process so health plans and providers can resolve eligible payment disputes without involving patients or affecting their protected cost-sharing responsibility. Originally forecast to produce fewer than 20,000 payer-provider disputes annually, the federal IDR process now receives more than 100 times the originally projected volume, creating significant complexity and administrative burden across the healthcare industry. Claritev’s newly published NSA Trend Report found that nearly 50% of the 2025 filings reviewed by the Company raised potential federal eligibility issues.
The new CMS data demonstrates the accelerating scale and financial significance of the federal IDR process:
- More than 2.5 million disputes filed in 2025, compared with 1.5 million in 2024
- 1.4 million disputes filed between July and December 2025, a 16% increase over the first half of 2025
- Total IDR awards exceeded $15 billion in 2025, more than triple the amount awarded in 2024
As dispute volume and awards continue to rise, so do the cost and the complexity of resolving payment disputes across the healthcare system. A well-functioning process helps identify ineligible claims earlier, resolve eligible disputes more efficiently, and reduce unnecessary administrative costs, helping make healthcare more affordable for patients.
As federal IDR volume and complexity have grown, clients have increasingly relied on Claritev’s end-to-end No Surprises Act capabilities. Claritev combines claims intelligence, eligibility review, its contracted provider network, and financial negotiation services to help resolve claims before they enter the federal IDR process. For disputes that cannot be resolved through those capabilities, Claritev supports clients with qualifying payment amount calculation, open negotiation, and federal IDR management.
Claritev 2025 Federal NSA/IDR Performance Highlights
Source: CMS Public Use Files and internal Claritev data
- Clients’ offers were selected in 20% of applicable determinations in 2025, compared with 12% industrywide. In the fourth quarter, that rate increased to 24%, compared with 15% industrywide.
- More than 1 million claims were priced using the qualifying payment amount methodology, demonstrating the scale of Claritev’s support before disputes enter federal IDR.
- Approximately 400,000 post-payment disputes were negotiated, helping clients pursue resolution before arbitration.
- Approximately 270,000 federal IDR arbitrations were managed, underscoring Claritev’s ability to operate at national scale.
Claritev continues to invest in responsible, AI-native capabilities, data, analytics, and workflow orchestration to help clients identify potential issues earlier, resolve more claims before arbitration, and manage disputes that proceed to federal IDR efficiently and consistently.
“The No Surprises Act and federal IDR process were created to protect patients while giving payers and providers a path to resolve payment disputes without placing that burden on the patient,” said Travis Dalton, CEO and President of Claritev. “We are proud that Claritev’s scale, expertise, and technology help our clients manage this increasingly complex process while supporting the law’s fundamental promise to patients.”
“Claritev’s results are grounded in three strengths: deep healthcare pricing and claims experience, longstanding relationships across the healthcare ecosystem, and responsible, data-driven technology that helps us manage rapidly rising filing volumes,” said Sean Crandell, SVP and GM of Claims Intelligence at Claritev. “While most payers and providers are working to meet the law’s requirements, high volumes of disputes with potential eligibility issues are adding cost and administrative burden to the process. We support efforts to strengthen eligibility controls, encourage meaningful negotiation, and help the federal IDR process operate as intended.”
About Claritev
Claritev is a healthcare technology, data, and insights company focused on delivering affordability, transparency, and quality across the U.S. healthcare system. Led by deeply experienced associates, data scientists, and innovators, Claritev provides technology-enabled solutions fueled by decades of claims expertise. The company leverages advanced analytics and AI to power a robust enterprise platform that delivers clear, actionable insights to support affordability, price transparency, and optimized network and benefits design. By supporting key stakeholders — including payers, employers, patients, providers, and third parties — Claritev is dedicated to making healthcare more accessible and affordable for all.
Claritev serves more than 750 healthcare payers, over 100,000 employers, 60 million consumers, and 1.4 million contracted providers. For more information, visit claritev.com.
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Jen O’Connor
VP, Brand Marketing
press@claritev.com
