Independent Dispute Resolution

The arbitration process established by the No Surprises Act for resolving payment disputes between out-of-network providers and payers when they cannot agree on a payment amount.

The Independent Dispute Resolution process, or IDR, is the mechanism created by the No Surprises Act for settling payment disputes between out-of-network providers and payers. When you provide a service that falls under the No Surprises Act protections and you cannot agree with the payer on a payment amount through open negotiation, either party can initiate IDR. The process works like baseball-style arbitration. Both you and the payer submit your proposed payment amount to a certified IDR entity (an independent arbitrator). The arbitrator picks one amount or the other. There is no splitting the difference. This incentivizes both sides to submit reasonable offers because an extreme position risks the arbitrator picking the other side's number. The arbitrator considers several factors: the qualifying payment amount (which is essentially the median in-network rate for the service in the geographic area), the provider's training and experience, the complexity of the service, patient acuity, market share of the provider and payer, and previous contracted rates between the parties. IDR has a 30-day open negotiation period before you can initiate the formal process. If negotiation fails, the initiating party pays a filing fee (currently around $50). The non-initiating party also pays a fee. The losing party pays the arbitrator's fee, which can range from $200 to $700 per dispute. Since the No Surprises Act took effect, hundreds of thousands of IDR disputes have been filed, far more than the government anticipated. The volume has created backlogs and processing delays. Some disputes take months to resolve. For most providers, the practical question is whether the expected IDR outcome justifies the administrative effort and cost of the process. For high-dollar services like emergency surgery or complex procedures, IDR can recover significant revenue. For lower-dollar services, the cost and time of the process may not be worth it. Calculate your expected recovery before filing.