How Federal IDR works, step by step
Federal independent dispute resolution (IDR) is the process the No Surprises Act created for out-of-network payment disputes between providers or facilities and health plans, when no state law applies. It is run by the Departments of Health and Human Services, Labor and the Treasury (CMS).
The steps
| Step | What happens | Source |
|---|---|---|
| 1. Initial payment or denial | The health plan sends an initial payment or a notice of denial within 30 calendar days after receiving the bill. | 42 U.S.C. 300gg-111 |
| 2. Open negotiation | Either side may start a 30-business-day open negotiation period, within 30 business days after the initial payment or denial. | 45 CFR 149.510(b) |
| 3. Initiation | If negotiation fails, either side may start Federal IDR within 4 business days after the negotiation period ends, unless the Departments grant an extension. | CMS |
| 4. Choosing the IDR entity | The parties may agree on a certified IDR entity; the non-initiating party agrees or objects within 3 business days after initiation. If they do not agree, the Departments select one. | 45 CFR 149.510(c)(1) |
| 5. Eligibility and fees | The IDR entity confirms the dispute is eligible. Each party pays a non-refundable administrative fee; for disputes started on or after June 11, 2026 it is $15 per party. The IDR entity fee is paid by the party whose offer is not selected. | 2026 final rule |
| 6. Offers | Each party submits a final payment offer and supporting information within 10 business days after the IDR entity is selected. | 45 CFR 149.510(c)(5) |
| 7. Decision | Within 30 business days after selection, the IDR entity picks one of the two offers (“baseball-style”). It must consider the QPA and other permitted information, and may not consider usual and customary charges, the provider’s billed charges, or public payer rates such as Medicare and Medicaid. | 45 CFR 149.510(c)(5) |
| 8. Payment | Any amount owed is paid within 30 calendar days after the decision. | CMS |
| 9. Cooling-off period | The party that started the dispute may not start a new one against the same party for the same item or service for 90 calendar days after a decision; claims from that period can be filed afterwards. | 45 CFR 149.510(c)(4)(vi) |
Deadlines are as stated in 45 CFR 149.510 and on the CMS IDR page; extensions can apply. Check current CMS notices before relying on any date.
Batching
Similar items or services between the same parties can be combined (“batched”) in one dispute. The 2026 Federal IDR Operations final rule (published June 4, 2026; effective August 3, 2026) revises the batching rules, including a limit of 50 line items per batched dispute for disputes whose open negotiation starts on or after November 1, 2026 (Federal Register).
Settling along the way
The parties can keep negotiating until the IDR entity decides. If they agree, the initiating party notifies the Departments and the IDR entity within 3 business days (CMS).
What the public data shows
CMS publishes quarterly public use files on disputes that reached a payment determination (CMS IDR reports). Withdrawn, settled and ineligible disputes are not among the determinations. This site counts 8,226,328 determined line items for 2023 Q1–2025 Q4; in 84.9% of them the provider or facility offer was selected (methodology, explorer).
Common questions
Who picks the winning offer?
A certified IDR entity, an independent organization certified by the Departments (CMS keeps the list of certified IDR entities).
Can the IDR entity choose an amount between the two offers?
No. It must select one of the two final offers (45 CFR 149.510(c)(5)).
How long does Federal IDR take?
By rule, the decision is due within 30 business days after the IDR entity is selected, following 30 business days of open negotiation. Actual times vary; this site shows median days to decision from CMS data.
More in Learn: The No Surprises Act, in plain English · What is the qualifying payment amount (QPA)? · Which services and specialties are covered? · State surprise billing laws and Federal IDR (including Texas) · Federal IDR glossary
General information, not legal advice. Rules change; check the cited sources. Last reviewed 2026-10-19.