Independent dispute resolution (IDR)

IDR is the step after negotiation. When a plan sends an initial payment or a denial notice on a claim the No Surprises Act protects, the provider or the plan starts an open negotiation period that lasts 30 business days¹. If it ends without agreement, either side can begin IDR, but only within the 4 business days that follow, unless the Departments allow an extension¹. The parties pick a certified IDR entity from the federal list, each submits a payment offer, and the entity has to choose one of the two offers rather than a figure in between. Whichever amount it picks is binding, and payment is due within 30 calendar days¹.

It is not an appeal. An appeal argues that a claim was denied or processed wrongly under the plan’s terms; IDR argues only about how much an out-of-network service should pay, and only for claims the law protects. Air ambulance providers, facilities and plans use the same process. It also costs money to use: each party pays a federal administrative fee for every dispute, and related line items can be grouped into one dispute when they meet the batching criteria.

The mistake is missing the windows. The negotiation follows the plan’s payment or denial notice, and the initiation window after it is only 4 business days, so a dispute started from a hunch weeks later is too late. Track protected claims from the remittance, write down the dates as they happen, and decide on IDR while the window is still open.