Stop writing off out of network claims.

Federal independent dispute resolution (IDR) is the No Surprises Act process for disputing a low out-of-network payment. The No Surprises Act, or NSA, is a federal law in effect since 2022 that protects patients from surprise bills for out-of-network care they could not reasonably avoid, such as emergency treatment or care from an out-of-network surgeon at an in-network facility. The patient pays only their in-network cost share, and the health plan and the provider settle the rest between themselves. That is where most disputes begin, because the plan's first payment is often far below the value of the work.

When the provider and the health plan cannot agree on a fair payment, either side can take the claim to independent dispute resolution. IDR is a federal arbitration process run by certified neutral entities. Both sides submit a single proposed payment amount with supporting evidence, and the arbiter picks one of the two offers. There is no splitting the difference, so the offer best supported by the evidence wins. The arbiter weighs the qualified payment amount, or QPA, against the provider's evidence on case complexity, surgeon training, and prior determinations for the same code and region, which is why out-of-network claim recovery depends so heavily on how the submission is built.

Federal IDR is most relevant to surgical specialties with high value procedures, including out-of-network care delivered at an in-network facility. It runs on strict clocks: you complete a 30 business day open negotiation period first, then have 4 business days to initiate IDR. Miss a window and the claim is closed for that cycle. As of 2026 a federal rule cut the administrative filing fees, opening No Surprises Act billing disputes to smaller practices that could not justify the cost before. CMS data shows 88 percent of properly filed federal IDR disputes result in a provider win (Source: Georgetown University CHIR, March 2026).