300
F
PayerScore · Third-party administrator · national
Total Plan Concepts
300 to 850 · lower is worse for providers · 575 = median payer conduct
97%
providers win their IDR disputes
859%
median award vs the payer's QPA
62%
payer default / non-response rate
73
resolved federal IDR disputes
Total Plan Concepts treats providers among the worst in the country. Providers win 97% of resolved federal IDR disputes against it nationally, at a median award of 859% of the payer's own qualifying payment amount. That is a documented signal of how far its offers sit below the amount the independent IDR arbiter selected.
Total Plan Concepts by state
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The interactive Payer Explorer shows the code-by-code detail, the dispute history, and where your own book sits against Total Plan Concepts. It is a documented reimbursement opportunity, modeled not guaranteed.
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About this grade. PayerScore is a modeled index and an opinion derived from disclosed public data, not a statement of fact about the payer's conduct. It is computed by deterministic method (v1.0.0) from public federal IDR dispute records (CMS Public Use File) and documented public rate positions vs the local peer median. These are federal independent-dispute-resolution records, not court judgments or litigation. Figures are modeled, not guaranteed. See the methodology. A payer may request a correction at corrections@reddenda.com.