What is IDR under the No Surprises Act?
The No Surprises Act protects patients from surprise bills. When out-of-network claims for emergency services, anesthesiology, radiology, critical care, pathology, or air ambulance are underpaid, providers and payers can take the dispute to an independent decision-maker. That process is called IDR — Independent Dispute Resolution.
The IDR Process Timeline
Understanding how disputes move from underpayment to resolution
Claim submitted and underpaid
Provider submits out-of-network claim. Payer issues payment below expected or fair reimbursement rate.
Provider and payer try to negotiate
30-day open negotiation period where both parties attempt to reach an agreement on payment amount.
Dispute goes to IDR with evidence submitted
Both sides submit their best offer and supporting evidence to an independent dispute resolution entity.
Independent entity chooses one offer
Arbitrator reviews evidence and selects either the provider's or payer's offer. No middle ground.
Final payment is set and must be honored
The chosen offer becomes the final payment amount. The losing party must pay within 30 days.
Where healthcare providers lose money
Common pitfalls that reduce IDR success rates
Provider offers way too high
Unrealistic offers above what arbitrators typically award based on historical data and market rates.
Evidence is weak or generic
Incomplete documentation, generic arguments, or evidence that doesn't address the specific case requirements.
Deadlines and rules are missed
Technical violations of timelines, submission formats, or procedural requirements that disqualify otherwise valid claims.
No clear data-driven strategy
Lack of analysis based on previous IDR decisions, QPA data, or specialty-specific benchmarks.
What IDR Advantage does differently
Our systematic approach to maximizing recovery
Data-informed offer calibration
We calibrate offers based on realistic, data-informed ranges from historical IDR outcomes and specialty-specific market benchmarks.
Specialty-tailored evidence packages
We assemble better evidence packages, customized by specialty, with relevant market data and clinical justification.
Timeline and compliance monitoring
We monitor all timelines and technical rules so cases don't get tossed on procedural technicalities.
Focus on net recovered dollars
We focus on actual dollars recovered, not just 'wins' on paper. Our success is measured by money in your account.
Frequently Asked Questions
Do we still need our billing/RCM team?
Yes, absolutely. Your billing and RCM team continues handling normal billing operations, claims submission, and day-to-day revenue cycle management. We focus exclusively on IDR disputes and underpayment recovery, working alongside your existing team without replacing them.
Are you a law firm?
No, we are not a law firm and do not provide legal advice. IDR Advantage provides IDR support, strategy, documentation, and dispute management services. For legal interpretation of the No Surprises Act and IDR regulations, please consult your legal counsel.
Do you work with payers?
No. We work exclusively with healthcare providers. We never represent or consult for insurance companies or payers. Our only focus is helping healthcare providers recover underpaid claims.
How long does the IDR process take?
The typical IDR timeline is 30-60 days from submission to decision, depending on the dispute resolution entity and complexity of the case. We manage all deadlines and keep you updated throughout the process.
Let's review a few of your underpaid claims
Send us a sample of recent disputes and we'll tell you if IDR Advantage can improve your outcomes.