How to read the Tennessee IDR market
Tennessee is one of the largest federal IDR markets in the CMS public files. For a provider group, the useful comparison is rarely the national average. The better question is how a payer behaves in the same state, service mix, and specialty lane.
The tables below show the payer, code, and IDR entity mix that shape Tennessee disputes. Use them to spot where an underpaid out-of-network book may deserve a closer NSA workflow review.
Top payers in Tennessee federal IDR disputes
| Payer | Disputes | Provider win rate |
|---|---|---|
| UnitedHealthcare | 26,589 | 88.8% |
| Cigna (cigna.com) | 17,311 | 82.6% |
| Cigna / MultiPlan | 13,140 | 79.4% |
| BLUECROSS BLUESHIELD OF TENNESSEE | 4,742 | 73.6% |
| UMR | 2,582 | 87.6% |
| UMR (clearhealthcloud.com) | 1,741 | 91.4% |
| AMBETTER | 1,547 | 96.7% |
| Cigna (zelis.com) | 1,101 | 86.4% |
Top service codes in Tennessee
| Code | Service | Disputes | Provider win rate |
|---|---|---|---|
| 99284 | Emergency department visit for the evaluation and management of a patient, which... | 20,117 | 86.1% |
| 99285 | Emergency department visit, high severity, requiring urgent evaluation | 12,555 | 86.1% |
| 80053 | Comprehensive metabolic panel (14 blood chemistry tests) | 5,429 | 82.5% |
| 85025 | Complete blood count (CBC) with automated differential | 5,004 | 82.5% |
| 99283 | Emergency department visit for the evaluation and management of a patient.... | 4,875 | 86.6% |
| 36415 | Routine venipuncture (blood draw) | 3,991 | 85.5% |
| 93005 | Electrocardiogram (ECG) tracing only, without interpretation | 2,928 | 84.9% |
| 74177 | CT scan of the abdomen and pelvis with IV contrast | 2,863 | 82.8% |
Certified IDR entity mix
| Certified IDR entity | Disputes | Provider win rate | Median award |
|---|---|---|---|
| C2C Innovative Solutions, Inc. | 6,449 | 87.2% | 2.9x |
| iMPROve Health | 4,812 | 91.9% | 3.4x |
| Federal Hearings and Appeals Services, Inc. | 3,352 | 86.5% | 3.0x |
| Provider Resources, Inc. | 3,061 | 92.5% | 2.6x |
| EdiPhy Advisors, L.L.C. | 2,249 | 92.7% | 3.0x |
| MCMC Services, LLC | 2,117 | 92.3% | 3.2x |
| Island Peer Review Organization | 2,069 | 97.8% | 3.5x |
Open the live Tennessee dashboard
Use the data explorer to filter Tennessee by specialty, payer, and year, then compare the results with your own disputed claims.
FAQ
How many federal IDR disputes are in Tennessee?
The Tennessee page currently shows 72,037 CMS disputes in the benchmark dataset.
What is the provider win rate in Tennessee?
The non-default provider win rate in Tennessee is 84.7% in this dataset.
Why can Tennessee differ from national IDR averages?
State, payer, service-code mix, and routing rules can change the economics of a dispute. That is why state-specific benchmarks are more useful than a single national win rate.
Related benchmarks
Sources and method
- CMS: Federal IDR reports and public use files
- CMS: About Independent Dispute Resolution
- CMS: Federal IDR timeline for claims
Data source: CMS Federal IDR public use files, coverage through 2025Q4; data build 2026-09-21. Counts are CMS dispute counts unless a table says line items. Win rates labeled non-default exclude payer no-show defaults. Award multiples are medians versus QPA. Dollar figures, where shown, are anchored estimates from CMS QPA-and-offer fields, not payment records. This page is informational, not legal or reimbursement advice.