Independent Dispute Resolution (IDR)
Independent Dispute Resolution
Under the No Surprises Act, the arbitration process for resolving payment disputes between OON providers and payers for protected services.
1 min read · Last reviewed May 23, 2026
At a glance
- Category
- Payer
- Acronym for
- Independent Dispute Resolution
- Primary sources
- 2
- Workspace handoff
- denial workbench →
Where this comes up
Front-office and billing both hit this term — eligibility before the visit, prior auth before the procedure, contract terms during fee-schedule negotiation, and credentialing whenever a new provider joins or a payer roster lapses. Misses here become denials downstream.
Full definition
What it is in practice
CMS IDR uses baseball-style arbitration: each side submits a payment offer; the IDR entity selects one. The process has filing fees and tight deadlines.
How it shows up in your practice
Track IDR-eligible encounters and the open-negotiation timeline. Many practices outsource IDR management to specialized firms.
Sources
- CMS — Independent Dispute Resolutionhttps://www.cms.gov/nosurprises/policies-and-resources/overview-of-rules-fact-sheets
- CMS — No Surprises Acthttps://www.cms.gov/nosurprises
Track IDR cases in the Denial Workbench
Open denial workbench →Related terms
- PayerNo Surprises ActFederal law effective January 1, 2022 that protects patients from surprise medical bills for emergency services, non-emergency services at in-network facilities by out-of-network providers, and air ambulance services.
- PayerPatient-Provider Dispute ResolutionUnder the No Surprises Act, the process by which uninsured or self-pay patients may dispute a bill that exceeds the Good Faith Estimate by $400 or more.
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Related across the archive
- GlossaryPatient-Provider Dispute ResolutionUnder the No Surprises Act, the process by which uninsured or self-pay patients may dispute a bill that exceeds the Good Faith Estimate by $400 or more.
- GlossaryNo Surprises ActFederal law effective January 1, 2022 that protects patients from surprise medical bills for emergency services, non-emergency services at in-network facilities by out-of-network providers, and air ambulance services.
- GlossaryAdvance Explanation of Benefits (AEOB)Under the No Surprises Act, the advance benefit statement that insurers must provide to insured patients before scheduled services (implementation deferred).
- GlossaryGood Faith Estimate (GFE)Under the No Surprises Act, the written estimate of expected charges providers must give to uninsured and self-pay patients prior to scheduled services.
- ComplianceOIG LEIE Monthly Exclusion Screening: Process + Audit-Ready LogsMonthly OIG LEIE and SAM.gov exclusion screening for every workforce member and vendor: the workflow, the log fields auditors require, and the escalation path.
- CompliancePECOS Provider Enrollment Verification (2026) — Quarterly ChecklistQuarterly PECOS provider enrollment verification workflow: who to check, the exact lookup steps, the audit log columns, and the revalidation escalation path.
- Glossary270/271 Eligibility Inquiry/ResponseThe HIPAA standard EDI transactions used to verify patient insurance eligibility (270 query, 271 response).
- GlossaryACA Marketplace PlanHealth plans sold through the federal or state-based health insurance marketplaces under the Affordable Care Act.
This glossary entry is a research aid for billing and compliance staff. It does not provide legal, medical, or financial advice and does not replace counsel. References cited link to primary sources at HHS, OCR, CMS, eCFR, NIST, and the relevant payer or industry body.