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No Surprises Act IDR in Illinois

Illinois: state arbitration vs. federal IDR for out-of-network claims

How Illinois' balance-billing arbitration works, which out-of-network claims go to federal IDR instead, and how we file for facility-based provider groups.

Illinois has its own arbitration track

Illinois prohibits out-of-network facility-based providers from balance billing patients who receive care at in-network hospitals and ambulatory surgery centers. When the provider and the insurer can't agree on payment, Illinois law provides a binding arbitration process to settle the amount — with the patient out of the middle.

Who it covers: state-regulated plans. Self-funded ERISA employer plans fall outside Illinois insurance law, so those claims run through the federal IDR process instead. Emergency and ancillary services under self-funded coverage are federal disputes.

Where groups lose money

  • Treating every underpaid remit the same way and filing everything on one track
  • Missing the state clock while waiting on a federal negotiation window, or vice versa
  • Accepting a repriced payment as final when the claim was arbitrable

What we do for Illinois groups

  • Plan-type screening on every out-of-network claim before filing
  • Open negotiation and arbitration filing on whichever track applies
  • Batching of federal disputes by payer and code
  • Follow-through on payment after an award — awards are due within 30 calendar days federally

We confirm the applicable process claim by claim before anything is filed.

Which process applies to your claims?

Send 90 days of out-of-network remits. We'll tell you claim by claim: federal IDR, state process, or not disputable — plus what comparable disputes have paid.

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Related

How federal IDR works
IDR eligibility checklist
Deadline calculator
Other states

Find out what your out-of-network claims are actually worth.

Send us a sample of recent OON remits. We'll tell you which claims are IDR-eligible, what similar disputes have paid, and what we'd file. No fee unless we win you more.

Request a free eligibility review