Federal Independent Dispute Resolution (IDR) Process

What is Independent Dispute Resolution?

Independent Dispute Resolution (IDR) is a process introduced in the No Surprise Act to resolve disputes between healthcare providers and insurers regarding out-of-network billing. It was added to the act on December 27, 2020, and is managed by the Department of Health and Human Services, the Department of Labor, and the Department of Treasury.

How does this new clause work for patients/healthcare organizations?

The inclusion of mechanisms like Independent Dispute Resolution (IDR) empowers healthcare organizations, on behalf of their patients to involve a certified IDR entity in resolving their billing disputes. This ensures that both parties have access to a fair and impartial process for resolving disagreements over medical bills, ultimately helping them find a way out of disputes transparently and equitably.

What is the process to initiate independent dispute resolution?

Before initiating a request, the healthcare provider must start open negotiations with the insurer. Consider attempting to resolve the dispute through direct negotiation with the healthcare provider or insurer before initiating the IDR process.

Familiarize yourself with your rights under the No Surprise Act and the specific procedures for initiating IDR, including any deadlines or requirements for submitting requests.

The IDR Process

1. Both parties must agree on selecting a certified Independent Dispute Resolution (IDR) entity from the list provided. This selection process ensures that both parties have confidence in the chosen IDR entity to handle the matter fairly. 
2. Both parties, the healthcare provider or patient and the insurer, will submit their payment offer with complete supporting documents to the certified IDR entity.
3. The certified IDR entity will review all the documents and situations and select a payment offer submitted by either the insurer, or healthcare provider, and the payment must be made within thirty days.

Note: The duration of an Open Negotiation period is typically 30 business days, after which one can initiate the Independent Dispute Resolution process. The Independent Dispute Resolution process must be commenced within four days following the conclusion of the Open Negotiation period except an extension is granted by the Department.

What information or documents are required to submit?

To identify the items or services eligible for the independent dispute resolution (IDR) process, one needs to provide the following information:

• Specify when and where the services were provided, e.g., date and location
• Indicate the nature of the services, such as emergency or post-stabilization care
• Mention appropriate codes for the services and their locations
• Supply a full copy of the EOB relevant to the claim.
• Provide the claim numbers that pertain to the dispute.
• Submit an attestation that the items or services are covered under the Federal IDR process.
• Offer full and accurate contact information for the non-initiating party.
• Mention your preferred certified IDR entity.

How can an extension be requested to submit information or documents?

Disputing parties should ensure they gather all their relevant information within the designated timeframe and submit it. However, if they find themselves in circumstances where they're unable to submit all required information due to unforeseen reasons, you can request an extension to extend your deadline. They can fill up the request for extension form and email it to fedralidrquestions@cms.hhs.gov to seek an extension.

How are Stat Medical Consulting, experts at helping, winning, and gaining more dollars for out-of-network facilities?

As experts in helping out-of-network facilities secure higher reimbursements from insurers, we focus on a range of areas to maximize your financial outcomes. We specialize in dispute resolution, skillfully navigating the complex process of submitting and managing disputes. Our experience enables us to present strong cases for higher reimbursements, drawing on proven negotiation tactics to advocate for the best possible rates on your behalf. We remain informed about the latest regulations and legal developments, ensuring compliance and taking advantage of every opportunity for increased payments.



We provide comprehensive guidance through the long and intricate IDR process, managing documentation and deadlines for efficient dispute resolution. Our expertise helps you maximize payouts from insurance companies, ultimately reducing your financial burden. By leveraging our knowledge and strategies, we work diligently to help you obtain more income from insurers and improve your facility's bottom line.