Federal IDR (No Surprises Act dispute resolution)

What it is

The Federal IDR process resolves payment disputes between out-of-network providers and health plans for services covered by the No Surprises Act (NSA) — emergency services, post-stabilization, air ambulance, and out-of-network providers at in-network facilities. Either party can initiate IDR after open negotiation fails. The IDR entity (a certified neutral) picks one party's offer as the final payment amount ('baseball arbitration'). Patient cost-sharing is NOT in dispute and is governed by NSA's in-network cost-sharing rules.

Who can use it

Out-of-network providers (most commonly anesthesiology, radiology, pathology groups, air ambulance carriers, emergency departments) and health plans. Patients are NOT parties to IDR — their cost-sharing is fixed by NSA at in-network levels.

When to use it

After open negotiation between provider and plan has been initiated and 30 business days have passed without resolution. The IDR window opens 4 business days after open negotiation closes.

Steps

1. Open negotiation. Provider or plan initiates open negotiation by sending a notice. 30 business days from the initial payment determination.
2. Initiate IDR. Either party files at the Federal IDR Portal (nsa-idr.cms.gov) within 4 business days after open negotiation ends.
3. IDR entity selection. Parties jointly select a certified IDR entity. If they can't agree, CMS randomly assigns one.
4. Submit offers. Each party submits its final offer + supporting documentation within 10 business days. Cannot rely on usual-and-customary database alone.
5. IDR decision. IDR entity picks ONE of the two offers as the final payment amount. Decision within 30 business days of selection.
6. Loser pays IDR fee. The party whose offer was NOT selected pays the IDR fee.

Key deadlines