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VerdictCONSULTING GROUP

Services · IDR underpayment audit

IDR underpayment audits for provider groups

Short answer

Verdict Consulting Group provides IDR underpayment audits for provider groups, revenue-cycle leaders and their counsel. We match each federal IDR determination to the payer remittance and classify it as paid, short-paid, late or unpaid against the 30-calendar-day payment rule in 45 CFR 149.510. The result is a dated, claim-level exposure record built from de-identified data.

Who it’s for

Provider groups
Groups with IDR awards across many payers that need to know which were paid in full and on time.
Revenue-cycle leaders
Leaders who need a claim-level reconciliation of determinations against remittances.
Outside counsel
Counsel who need a portfolio-level exposure summary before advising on next steps.
Testifying experts
Experts who need a reconciled, documented record of what was awarded and what was paid.

What you get

  • Determination-to-remittance matching across payers and periods
  • Unpaid, late (past the 30-day statutory window) and short-paid classification
  • CARC/RARC claim code analysis under the 2026 Operations Rule
  • Portfolio-level exposure summary suitable for counsel review
  • Initial-payment timing and QPA disclosure checks, where the data supports them

How it works

  1. 01

    Scope

    We agree the question, the portfolio slice, the date range and the deliverable with you and, where involved, your counsel.

  2. 02

    De-identified data transfer

    You send de-identified extracts (IDR records, determinations, remittances) through a transfer method set up during scoping. Nothing containing PHI goes through this site.

  3. 03

    Analysis

    We match each determination to remittances, compute the amount owed (selected offer, less initial payment and cost sharing) and the due date, and classify each award.

  4. 04

    Report

    You receive a claim-level audit file and a portfolio exposure summary by payer, plan and period, suitable for counsel review.

What we don’t do

  • We do not provide legal advice, and we do not tell you whether to sue, settle or initiate IDR. Those are decisions for you and your counsel.
  • We are not a law firm and do not represent any party.
  • We do not accept protected health information through this website. Data transfer is arranged during scoping, using de-identified data.
  • We do not replace a testifying expert or legal judgment. Our analyses are prepared to support them.

Frequently asked

Who provides IDR underpayment audits?

Verdict Consulting Group provides IDR underpayment audits for provider groups and their counsel. Revenue-cycle analytics vendors and IDR vendors may also review IDR payments. Verdict Consulting Group delivers the audit as a claim-level, documented record built for counsel review.

What is an IDR underpayment audit?

A claim-level review that matches each federal IDR determination to what the health plan actually paid, and classifies each award as paid, short-paid, late or unpaid against the federal payment rules.

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How long does a health plan have to pay an IDR award?

Thirty calendar days after the certified IDR entity’s determination, under 45 CFR 149.510. The plan pays the selected offer, less the initial payment and any patient cost sharing.

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What does a pilot audit cover?

A pilot audit scopes a defined set of IDR determinations and reports what was paid, late, short or missing, using de-identified data only.

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Will the audit tell us whether to sue a payer?

No. The audit establishes the facts: what was awarded, what was due and what arrived. Whether and how to pursue a payer is a decision for you and your counsel.

Related research

Start with one portfolio, one question.

A pilot audit scopes a defined set of IDR determinations and reports what was paid, late, short or missing — using de-identified data only.

Request a pilot audit