Answers / What is federal IDR
What is federal IDR?
Federal IDR is the independent dispute resolution process created by the No Surprises Act, in effect since January 2022. It resolves payment disputes between out-of-network providers and health plans through baseball-style arbitration: each side submits one offer, a certified IDR entity picks one, and the decision is binding on both parties.
Where it came from
The No Surprises Act, passed in December 2020 and effective January 2022, banned balance billing patients for emergency care and for out-of-network care at in-network facilities. That solved the patient's problem and created a new one: someone still has to decide what the plan owes the provider. Congress's answer was federal IDR, a mandatory arbitration process run by CMS on behalf of the federal government.
How a dispute moves
Everything runs on deadlines. The payer's initial payment or denial starts a 30 business day window to open negotiation. Negotiation runs 30 business days. If it fails, the provider has 4 business days to initiate arbitration in the federal portal. The parties get 3 business days to agree on a certified IDR entity, or CMS assigns one. Each side submits one payment offer with evidence within 10 business days of selection, and the decision comes within 30 business days after that.
Why it is called baseball-style
The arbitrator cannot split the difference. One offer wins, the other loses, which is how salary arbitration works in Major League Baseball. The design punishes unreasonable offers: a lowball payer offer or an inflated provider offer is easy for the other side to beat. The arbitrator weighs each offer against the qualifying payment amount and the statutory factors, including patient acuity, the provider's training and experience, market share, scope of services, and prior contracting history. Billed charges and government program rates are off the table by law.
What it is not
Federal IDR is not a lawsuit, not a hearing, and not a negotiation with the government. It is an administrative paper process decided on written submissions. It is also not optional for payers: once a provider initiates an eligible dispute under the No Surprises Act, the plan is in the process whether it engages or not, and the decision binds it. The payer must pay the award within 30 calendar days.
See where your claims fit
Lido IDR screens your out-of-network claims for eligibility and files the ones that qualify, for a flat fee per arbitration. Talk to an IDR specialist.