IDR arbitration: how the federal No Surprises Act process works

One process, hard deadlines, and a public record that favors providers.

When a health plan underpays an out-of-network claim, the No Surprises Act gives providers a federal arbitration process called independent dispute resolution (IDR). Every decision is published, so there is no need to guess how it goes: 3.39 million disputes are on the record, providers won 85.8 percent of them, and the median decision took 37 days. This site explains the process from that record, and the team behind it files IDR arbitration cases for providers for a flat fee per arbitration.

All 3.39 million federal IDR disputes published by CMS, 2023 through 2025. Explore the data at idrexplorer.com.

How IDR arbitration works, step by step

The process runs on business day clocks, and missing any one of them usually ends the claim. Here is the whole sequence:

1. The payer's payment or denial starts the clock. From the date you receive a compliant initial payment or notice of denial, you have 30 business days to send the payer an open negotiation notice.
2. Open negotiation runs 30 business days. Most payers do not move. The window exists so both sides can settle, but its real function for providers is starting the path to arbitration.
3. You have 4 business days to file. After the negotiation window closes, there is a 4 business day window to initiate IDR arbitration through the federal portal. This is the deadline that kills the most claims.
4. Both sides submit one offer each. Within 10 business days of the certified IDR entity being selected, each party submits a single payment offer with supporting evidence. The arbitrator must pick one offer in full.
5. Decision, then payment. The decision is due 30 business days after the entity is selected; the median published decision took 37 days. The losing party forfeits its entity fee deposit, and the payer must pay the award within 30 calendar days.

The deadlines, what happens when payers miss theirs, and what a realistic calendar looks like from date of service to money in the bank are in our timeline guide.

The record at a glance

Every federal IDR decision is published by CMS. Here is what the full record shows, 2023 through 2025:

Computed at the dispute level from the CMS federal IDR public use files, 2023 through 2025.

The win rate is not a quirk of one specialty. Emergency medicine, radiology, anesthesia, and surgery all clear 80 percent, and surgical specialties alone account for more than 136,000 published disputes (that record is broken out at idrforsurgeons.com). The full database, searchable by payer, state, specialty, and IDR entity, is at idrexplorer.com. Who wins, which payers lose most often, and why the rate is so lopsided: who wins IDR arbitration.

What the arbitrator actually decides

The arbitrator does not set a fair price. They pick one of the two offers, and the No Surprises Act tells them what to weigh. The anchor is the qualifying payment amount (QPA), which is the payer's own median contracted rate for the service in that market. The payer's offer usually sits at or near the QPA.

The statute then lists additional factors the arbitrator must consider when a party raises them: the provider's training, experience, and quality outcomes, the market share of either party, the acuity of the patient and complexity of the case, the scope of services the provider or facility offers, and prior contracting history between the two sides. Evidence on those factors is how provider offers at multiples of the QPA win 85.8 percent of the time. One thing arbitrators may not consider: billed charges, and government program rates like Medicare.

Who can use IDR arbitration

The process covers commercial claims through two doors:

• Emergency services. Care that begins in an emergency department, including the out-of-network physicians who treat the patient there and post-stabilization care. Patients cannot waive these protections.
• Out-of-network care at an in-network facility. Services you deliver at a hospital or ambulatory surgery center that is in the patient's network while you are not. For scheduled care a payer may argue the patient signed a notice and consent waiver, but federal rules list services that can never be waived: anesthesiology, pathology, radiology, assistant surgeons, and related ancillary services among them.

Care delivered in your own office does not qualify, and Medicare, Medicaid, and self-pay patients are outside the process. Some states run their own arbitration systems for state-regulated plans; the federal process covers self-funded employer plans everywhere. General eligibility questions beyond this page are covered in the Lido IDR answers library.

What IDR arbitration costs

Three layers of cost, two of them small:

• The federal administrative fee is $15 per party per dispute. Claims against the same payer for the same or similar services within a 30 business day window can be batched into a single dispute, so one fee can cover a stack of claims.
• The certified IDR entity's fee is a refundable deposit. Both sides pay it up front, and the winner gets it back. The loser funds the arbitration.
• The filer's fee is the real variable. Most IDR vendors and law firms charge 15 to 25 percent of the recovery. On the awards in the published record, that is routinely thousands of dollars per dispute. Lido IDR charges a flat fee per arbitration instead, so the award is entirely yours.

The complete cost picture, including what happens to fees when you lose and how batching changes the math on small claims, is in our fees guide.