Certified IDR entities are a foundational component of the federal IDR process under the No Surprises Act. As neutral, independent decision-makers, IDR entities are responsible for evaluating disputes and issuing payment determinations based on the information and criteria established by Congress in statute. Maintaining their full and active role is essential to ensuring the process operates as intended.

CIDRE supports policies that protect and reinforce the central role of IDR entities across the dispute resolution lifecycle including eligibility determinations, dispute administration, and final payment determinations. Limiting or diminishing the involvement of certified entities risks undermining the independence, consistency, and impartiality that are critical to credible dispute resolution and threatens to unwind the careful balance achieved by Congress that ended surprise bills for millions of Americans.

A strong and appropriately engaged IDR framework promotes objective decision-making, procedural consistency, and accountability. It also helps ensure that disputes are resolved by qualified, neutral entities with the expertise necessary to manage complex clinical and financial considerations.

In June 2025, the U.S. Court of Appeals for the 5th Circuit found that IDREs are entitled to legislative immunity in their role as arbitrators. See Guardian Flight, L.L.C. v. Medical Evaluators of Texas ASO, L.L.C. 140 F.4th 613 (5th Cir. 2025).

When IDREs exercise their authority, they should not face unnecessary litigation challenging their decisions that disrupts case administration or discourages qualified participation.

Accordingly, CIDRE endeavors to help establish legislative immunity for IDR entities. Legislative immunity memorialized in the NSA would provide statutory clarity on the issue and would serve to support the 5th Circuit’s recent decision.

See Guardian Flight, L.L.C. v. Medical Evaluators of Texas ASO, L.L.C., 140 F.4th 613 (5th Cir. 2025)

To function effectively, IDR entities must be able to carry out these responsibilities independently and without undue risk of litigation related to their determinations.

CIDRE supports legislative and regulatory efforts that provide appropriate legal protections for IDR entities when they are acting within the scope of their certified duties. Clear protections help ensure that IDR entities can make impartial decisions based solely on the merits of each case, without the concern that good-faith determinations will lead to unnecessary or burdensome legal challenges.

This need for protection is reinforced by recent judicial recognition of the quasi-judicial role of IDR entities. In Guardian Flight, L.L.C. v. Medical Evaluators of Texas ASO, L.L.C., 140 F.4th 613 (5th Cir. 2025), the U.S. Court of Appeals for the Fifth Circuit found that IDR entities are entitled to legislative immunity in their role as arbitrators. This underscores the importance of safeguarding IDR entities as they perform functions that are integral to an impartial dispute resolution system.

Limiting litigation risk for IDR entities is important to preserving the stability, efficiency, and independence of the IDR process. Without such protections, the ability of certified entities to operate effectively may be compromised, potentially impacting timelines, consistency, and overall system performance.

By supporting targeted legislative safeguards, CIDRE aims to help maintain a dispute resolution environment where IDR entities can focus on their core function—issuing fair, consistent, and evidence-based determinations in alignment with the goals of the No Surprises Act, while supporting the broader objective of protecting patients from surprise medical bills.