Independent dispute resolution, explained for providers

What independent dispute resolution is

Independent dispute resolution is the arbitration process created by the No Surprises Act to settle what a health plan owes an out-of-network provider for services the patient can't be balance billed for — emergency care, out-of-network care delivered at in-network facilities, and air ambulance transport. The patient is removed from the dispute entirely; it's a payment fight between the provider and the plan.

It is final-offer arbitration. Both sides submit a single payment amount. A certified IDR entity picks one of the two. There is no splitting the difference, no negotiated middle. That structure is why offer strategy matters more than volume.

Who can initiate, and when

• Either party can start it, but in practice providers initiate the overwhelming majority of disputes.
• First comes open negotiation: 30 business days from the initial payment or denial.
• If that fails, the initiating party has four business days after the negotiation period ends to open the dispute. Miss it and the claim is dead.
• The parties then have 10 business days to agree on a certified IDR entity; if they can't, one is assigned.

What the arbitrator can and cannot weigh

The certified IDR entity must consider the qualifying payment amount — the plan's median contracted rate for the service — and may consider additional credible information: the provider's training and experience, case acuity and complexity, the facility's teaching status and case mix, market share, and prior contracting history between the parties.

What the outcomes look like

• Volume has been far beyond what regulators projected — more than 5.1 million disputes had been submitted through January 31, 2026.
• Providers have prevailed in roughly 88% of determinations, according to federal data, and winning awards frequently land at several times comparable in-network rates.
• The dominant reason disputes fail isn't the merits — it's eligibility and timing.

What changed in 2026

The May 2026 final rule cut the administrative fee from $115 to $15 per party, expanded batching, put deadlines on eligibility review, and set up a new centralized IDR Gateway. It is meaningfully cheaper to file now than it was a year ago.

Federal or state?

Twenty-two states have their own surprise-billing protections, and in nearly all of them the state law covers only part of the field — self-funded ERISA plans still go federal. Routing a claim to the wrong forum is a common, fatal error. See IDR by state.