Federal IDR: the No Surprises Act dispute process explained

Who runs it, who can use it, who wins, and what it costs. Built from all 3.39 million published disputes.

Federal IDR is the arbitration system Congress built into the No Surprises Act, and it has become one of the most provider-favorable forums in American healthcare. This site explains the process in plain language and grounds every claim in the published federal record.

All 3.39 million federal IDR disputes published by CMS, 2023 through 2025. Explore the data at idrexplorer.com.

How federal IDR works

The process is baseball-style arbitration. It starts when a payer pays or denies a protected out-of-network claim: the provider has 30 business days to open negotiation, the negotiation window runs 30 business days, and if it fails the provider has 4 business days to initiate arbitration in the federal portal. Each side then submits one payment offer with evidence within 10 business days of the arbitrator being selected, and the certified IDR entity must choose one of the two offers, nothing in between, within 30 business days.

The arbitrator weighs the qualifying payment amount, the payer's own median in-network rate, along with training and experience, patient acuity and case complexity, market share, scope of services, and prior contracting history. Billed charges and government program rates may not be considered. The decision is binding, and the payer must pay within 30 calendar days.

Who can use it

Two kinds of claims are eligible. The first is emergency services, from the ER through post-stabilization care. The second is out-of-network care delivered at an in-network hospital or ambulatory surgery center, which is how anesthesiologists, radiologists, pathologists, surgical assistants, and hospital-based specialists end up in the process. Air ambulance disputes have their own parallel track.

Office visits, Medicare, Medicaid, and self-pay patients are outside the federal process. For scheduled care at an in-network facility, some specialties can lose protection if the patient signs a valid notice-and-consent waiver, but the No Surprises Act makes consent impossible for ancillary specialties like anesthesiology, pathology, radiology, and assistant surgeons.

The record so far

When the rules were written, the government projected roughly 22,000 disputes a year. Providers filed hundreds of thousands instead: the CMS public use files for 2023 through 2025 publish 3.39 million disputes. Providers won 85.8 percent of decisions, the typical award landed around 4.7 times the qualifying payment amount, and the median dispute took 37 days from arbitrator selection to decision. The full record is explorable at idrexplorer.com.

What it costs

The government charges each party a $15 administrative fee per dispute. The certified IDR entity charges a few hundred dollars per dispute, set within government-approved ranges, paid by both sides as a deposit and refunded to the winner. The real cost decision is who does the work: most filing vendors and law firms charge 15 to 25 percent of the recovery, while Lido IDR files for a flat fee per arbitration.