Resource
Federal IDR Eligibility Checklist
A threshold checklist for evaluating whether an out-of-network claim may fit the Federal IDR process.
Confirm the coverage
Identify the plan or issuer, funding arrangement, governing state, and any self-funded plan election into a state process.
Confirm the service
Check whether the item is an emergency service, covered post-stabilization service, qualifying nonemergency service at a covered in-network facility, or air ambulance service.
Confirm the forum and dates
Determine whether state law or an All-Payer Model sets payment, then document the initial payment or denial and negotiation dates.