From the Desk of Callagy Recovery
The No Surprises Act (NSA) was introduced to protect patients from unexpected out-of-network medical bills. However, it also introduced new burdens for medical providers – especially when fair reimbursement from payors doesn’t align with the value of care provided. That’s where the Independent Dispute Resolution (IDR) process comes in. At Callagy Recovery Corp, we’ve helped countless providers understand and leverage this process to recover rightful payments. Here’s a clear, step-by-step breakdown of how to navigate the IDR process efficiently and effectively.
Step 1: Verify Eligibility for IDR
- The service must be covered by the No Surprises Act (emergency services, non-emergency services at in-network facilities, air ambulance).
- The dispute must be between a provider and a group health plan or insurer.
- State laws must not already govern the dispute. (Some states have their own processes.)
Tip: Not all disputes are eligible – check for batching eligibility too, which allows similar claims to be grouped together.
Step 2: Negotiate First
Within 30 business days of receiving an initial payment or denial from the payor, the provider must initiate a 30-day open negotiation period.
Key Action: Submit a written notice to the plan or insurer to trigger this period.
Remember: You cannot file for IDR unless this step is completed. If the negotiation leads to an agreement, the process ends here.
Step 3: Initiate the IDR Process
If no resolution is reached after open negotiation, you have 4 business days to initiate the IDR process.
- File via the federal IDR portal.
- Pay the administrative fee ($50 as of now, subject to change).
- Choose a certified IDR entity, or the government will assign one if parties can’t agree.
Documentation Needed: Initial payment/denial, amount sought, evidence supporting your rate.
Step 4: Submit Your Offer and Supporting Materials
Once the IDR entity is assigned, both parties have 10 business days to submit their final offers and supporting documentation.
Pro Tip from Callagy: Present compelling data – highlight clinical complexity, geography, provider expertise, and prior negotiations.
Step 5: Let the Arbitrator Decide
The certified IDR entity must select one of the two offers within 30 business days.
Decision Factors Include:
- The Qualifying Payment Amount (QPA)
- Level of training, experience, and quality of outcomes
- Patient acuity, market rates, and previous contracts
Step 6: Payment and Outcome
If the provider’s offer is chosen, the payor must remit payment within 30 days. If the payor wins, no additional payment is required.
The losing party is responsible for the IDR entity’s fee, which can range from $200–$700+ depending on complexity.
How Callagy Recovery Corp Helps
Navigating the IDR process is time-sensitive and document-heavy. At Callagy Recovery Corp:
- We manage the entire process – from open negotiations through to IDR filings.
- We maximize reimbursements – leveraging data and legal expertise.
- We keep you compliant – avoiding errors that lead to denials.
If you’re a medical provider frustrated by inadequate reimbursements, don’t navigate the IDR process alone.
Contact Callagy Recovery Corp today, and let’s recover what you’re truly owed.
Call us at (201) 261-1700 or visit callagyrecovery.com