What is federal IDR? The arbitration process most surgeons have never heard of.

Common questions about federal IDR

What is independent dispute resolution under the No Surprises Act?

Independent dispute resolution (IDR) is the federal arbitration process created by the No Surprises Act. Since January 2022, out of network providers in protected situations can dispute insurer underpayments. Each side submits a payment offer with evidence. A certified IDR entity picks one offer. The decision binds both parties. Providers won 88% of federal IDR disputes in the first half of 2025, per CMS data released January 2026.

What evidence wins at IDR (FAIR Health benchmarks, case complexity, prior contracted rates, physician training)?

Arbitrators weigh several factors: FAIR Health or other market rate benchmarks for the specific CPT code, case complexity and clinical circumstances documented in the operative note, physician training and credentials, prior contracted rates with the payer where available, and whether the claim was filed as one dispute per CPT code. Kronos prepares all of these on every submission.

How long does the IDR process take?

The clock starts when the insurer issues its initial payment or denial. From that date you have 30 business days to initiate open negotiation, and skipping this step forfeits the claim. Negotiation runs 30 business days. If no agreement is reached, either party has 4 business days to initiate federal IDR. The certified IDR entity then issues a binding determination, and payment is due within 30 calendar days. Kronos Revenue targets under 5 business days from EOB receipt to filing and tracks every window so nothing expires.

Federal IDR vs state surprise billing law, which applies?

Federal IDR under the No Surprises Act applies to most employer sponsored and marketplace plans. In states with their own surprise billing laws including Texas, New York, California, New Jersey, and Florida, state law may govern disputes involving fully insured state regulated plans. Kronos Revenue navigates both federal and state pathways and confirms which applies before filing.

What claims are eligible for federal IDR?

Eligible claims include out of network items or services covered under the NSA where the insurer issued an initial payment or denial, open negotiation was initiated within 30 business days, and no active cooling off period applies for that CPT code and payer combination. Grandfathered plans, short term plans, and retiree only plans are excluded. Kronos verifies eligibility before every submission.

Can I still negotiate after initiating IDR?

Yes. Parties may continue negotiating until the certified IDR entity issues a binding determination. Many disputes settle during the IDR process before a final decision. Initiating IDR does not forfeit your right to reach agreement with the payer before the determination.