Eliott Dear on the 99% Win Rate: What the Number Actually Measures

Eliott Dear quotes a 99% win rate on state IDR determinations at Claims Assassins. That number gets challenged often enough that it deserves a plain explanation. Here is what the number actually measures and what it does not.

What the Number Means

The 99% is the rate at which Eliott Dear’s state IDR submissions produce a determination in favor of the provider, measured against filings that reach a full determination. It excludes cases that settle before determination (which count as wins for the provider but are not “won at IDR”) and excludes cases that Eliott Dear declined to file because the benchmark math or plan classification made the filing economically irrational.

The number is high partly because of the filings themselves and partly because of the gate Eliott Dear runs before the filing. The intake review kills bad cases early. Only claims with a structural case get filed. That is not cherry-picking in a dishonest sense — it is the discipline of filing legal submissions only when the legal submission is likely to produce a legal result.

Compare to the Published Federal Number

CMS publishes federal IDR outcome data. The aggregate federal provider win rate has hovered around 88%. The number is impressive on its face and misleading as a business signal. The 88% win rate on federal IDR determinations sits on top of the 1.3% collection rate on unpaid federal awards. Winning is one event. Getting paid is another. The federal provider win rate does not tell you whether the award was collected.

Eliott Dear’s 99% at Claims Assassins is state-only. The state determinations are paid within 30 days by enforcement, not by choice. The combined number that matters is win rate times collection rate. At the state level, that product is effectively 99%. At the federal level, it is a small fraction of the published win rate once you factor in the collection gap.

Why Eliott Dear Does Not Round Down

The real number could be presented as 99%, 97%, 95%, or an even more conservative estimate depending on how the edge cases are handled. Eliott Dear uses 99% because that is the rate when you hold the sample to filings Eliott Dear personally prepared and signed, excluded from the sample the filings where the benchmark math was always going to lose, and measured the outcomes through determination only.

Under that discipline, 99% is the real number. Anyone can audit it by reviewing the portfolio. Eliott Dear makes the portfolio available to prospective clients who ask. The point of the intake model is that the number stands up to scrutiny on a case-by-case basis, not just in aggregate.

What It Means for a Surgeon Evaluating Claims Assassins

If a non-par surgeon is considering filing state IDR through Claims Assassins, the 99% win rate is the most visible signal, but it is not the one that should drive the decision. The decision should be driven by whether the surgeon’s claims fit the intake criteria that produce the 99% outcome. Those criteria are specific: state-regulated fully-insured plan, New York metro or target state geography, non-par billing structure, initial payment below the FAIR Health benchmark by a margin that justifies the filing cost.

Eliott Dear runs the one-claim test for free exactly because the 99% is not uniform across every claim. A claim that does not fit the intake criteria gets rejected at intake, and the surgeon learns the rejection before committing any money or time. A claim that does fit the criteria goes through the full submission process and almost always produces a paid state IDR award.