Resource
Independent Dispute Resolution: A Provider Overview
A practical overview of state and federal processes for resolving certain out-of-network payment disputes.
What IDR addresses
IDR can determine the out-of-network payment amount for certain services when a provider or facility and a plan or issuer do not agree. The governing forum depends on the claim, plan, service, and applicable law.
What happens first
Federal IDR generally requires a 30-business-day open-negotiation period before initiation. State programs use their own prerequisites and schedules.