IDR (Independent Dispute Resolution)

Independent Dispute Resolution (IDR) is the federal arbitration process created by the No Surprises Act to resolve payment disputes between out-of-network providers and health plans for services covered under the surprise-billing protections. When a provider thinks the plan's payment is too low, they can initiate IDR through a certified independent dispute resolution entity. Both sides submit a proposed payment amount and the arbitrator picks one — "baseball arbitration" style.

The mechanics: after the plan makes an initial payment, either party has 30 business days to initiate a 30-day open negotiation period. If negotiation fails, the case goes to IDR. Each side submits a payment offer with supporting evidence. The arbitrator considers the qualifying payment amount (the plan's median in-network rate for similar services), the provider's training and experience, market share of both parties, patient acuity, and other factors. The losing party pays the arbitration fee (currently several hundred dollars). Volume has been massive — hundreds of thousands of IDR cases have been filed, dwarfing initial estimates — and the CMS has struggled with backlogs and litigation over the exact weighting of the qualifying payment amount.

The takeaway: IDR is a provider-versus-plan process — patients aren't parties to it. But the outcome affects future in-network negotiations and how plans price out-of-network claims. If you're a self-funded employer, ask your TPA how they handle IDR cases and what the aggregate outcomes have looked like.