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ABOUT CIDRE

Understanding the Federal IDR Process

The IDR process is a federal framework established under the No Surprises Act to resolve payment disputes between healthcare providers and health plans - protecting patients from unexpected medical bills through independent, neutral arbitration.

"By protecting the IDR community, we strengthen the broader goal of the No Surprises framework - shielding patients from unexpected medical bills while maintaining a fair and functional healthcare payment system."
CIDRE MISSION STATEMENT

100K+

Disputes via IDR

90%

Disputes settled without IDR 

$0

Additional patient liability 

2022

No Surprises Act enacted 

THE IDR PROCESS

How Independent Dispute Resolution Works

The IDR process is a federal mechanism established under the No Surprises Act to resolve payment disputes between healthcare providers and health plans for certain out-of-network services. The process ensures that patients are protected from unexpected medical bills while allowing providers and plans to reach a fair payment determination through an independent third party.

When a dispute arises, providers and health plans first enter a 30-business-day open negotiation period. If no agreement is reached, either party may initiate the IDR process. A certified IDR entity — an independent and neutral organization authorized by CMS — reviews the information submitted by both parties and determines the appropriate payment amount based on factors outlined in federal law.

Importantly, patients are not involved in this process and are held harmless from additional costs beyond their in-network cost-sharing responsibilities.

Open Negotiation

Providers and health plans enter a 30-business-day negotiation period to attempt to resolve the payment dispute on their own.

IDR Initiated

If no agreement is reached, either party may initiate the federal IDR process by submitting the dispute to a certified IDR entity.

Baseball-Style Arbitration

Each party submits one offer. The certified IDRE measures each offer against four specific statutory criteria set by Congress and selects the most appropriate offer - it cannot compromise between offers.

Determination Issued

The party whose offer best reflects the statutory criteria prevails at the amount of their offer. Patients remain fully protected and pay nothing beyond their in-network cost-sharing.

IDR IN PRACTICE

The Process Since Implementation

Since its implementation under the No Surprises Act, the IDR process has become a critical framework for resolving payment disputes between providers and health plans — while keeping patients entirely out of the process.

Hundreds of Thousands Resolved

Hundreds of thousands of disputes between health insurers and out-of-network providers have been submitted through the federal IDR process, reflecting its role as an active and accessible resolution pathway for all stakeholders. 

Patients Fully Protected

Patients are not responsible for any disputed amounts beyond their in-network cost-sharing obligations and are not involved in the dispute process at all. The NSA has successfully prevented surprise bills for all covered services since 2022. 

90% Settled Without IDR

The insurance industry estimates that in 2024 there were 20 million out-of-network claims in total — approximately 90% were resolved by plans and providers without any third-party IDR assistance. 

Cost-Effective Resolution

Compared to traditional dispute mechanisms such as litigation or arbitration, the IDR process is highly cost-effective — typically less than $1,500 per dispute, saving money for all stakeholders including consumers. 

Continuous Improvement

The IDR process continues to evolve as federal agencies refine guidance, enhance system functionality, and improve operational efficiency. As parties gain experience and calibrate their offers more closely to statutory criteria, outcomes are expected to become increasingly balanced between providers and insurance plans. Ongoing updates help ensure the process remains fair, transparent, and effective for all stakeholders. 

CIDRE'S MISSION

Committed to a Balanced, Independent IDR Process

CIDRE advocates for fair, transparent, and balanced policies that protect the integrity of the processes meant to shield patients from surprise medical billing. We educate lawmakers, regulators, and stakeholders on the operational realities and public value of the IDR system.

Regulatory Stability & Clarity

Promoting regulatory clarity that allows IDR entities to operate efficiently and impartially, with consistent rules that all parties can rely on. 

Process Independence

Defending the independence of the dispute resolution process from undue influence, ensuring certified entities can make impartial decisions on the merits of each case. 

Evidence-Based Policy

Supporting evidence-based policymaking that maintains a fair balance between providers, payers, and patients — consistent with the Congressional design of the No Surprises Act. 

Stakeholder Education

Informing lawmakers, regulators, and stakeholders on the operational realities and public value of the IDR system so that policy decisions are grounded in how the process actually works. 

A BALANCED FRAMEWORK

How the IDR Process Promotes Fairness

P
Providers
Providers submit an offer that is measured against statutory criteria set by Congress. Since the No Surprises Act was enacted, provider in-network participation rates have actually increased — from 90% to 93% — demonstrating that the IDR process supports, rather than disrupts, the in-network system.
H
Health Plans
Health plans submit their own offer, and the IDR entity selects the offer that best represents the value of the item or service. The structure encourages reasonable, good-faith offers from all parties and supports consistency and transparency in how disputes are resolved.
Pt
Patients
Patients are entirely insulated from the dispute process. They pay only their in-network cost-sharing amounts and bear no responsibility for any disputed amounts. The No Surprises Act has successfully protected Americans from surprise medical bills for all covered services since its enactment.

Get In Touch

Questions about CIDRE’s work or membership?
We’d love to hear from you.
Mary Jane Rodes, Association Manager

maryjane@rodesconsulting.com

2020 Pennsylvania Ave NW, Suite 511
Washington, DC 20006