THE IDR Process Explained

This is the first deadline Claimants need to be aware of.

The Claimant has 30 Business days from the date of the EOB to send the letter of Negotiation to the insurance carrier.

Once the Letter of Negotiation is sent, The Claimant is now in the Negotiation Period

The negotiation period’s purpose is to have the Carrier and Provider/Facility negotiate and ultimately settle outside arbitration.

Once the Open negotiation letter is sent, Parties must exhaust a 30-business-day open negotiation period and wait before either party may initiate the Federal IDR Process.

This is the Second deadline Claimants need to be aware of.

Either party can initiate the Federal IDR Process by submitting a Notice of IDR Initiation to the other party and to the Departments within 4 business days after the close of the open negotiation period.

This is the third deadline Claimants need to be aware of.

During the application providers will be required to upload proof of the letter of negotiation, and proof that they have sent the letter of Negotiation to the carrier.

Furthermore during this application the Claimant can choose the IDR entity (Advanced Arbitration) from drop down list.

Lastly after completing the form, the dispute the Claimant MUST send a copy of the Notice of IDR dispute to the opposing Party. (Simply click “Save PDF” and email it to the Respondent).

Please take note that this is neither the time nor the place for submitting your comprehensive brief outlining all your arguments in favor of winning. This stage is merely a precursor, and the submission of such a brief occurs later in Step 6 of the process.

The non-initiating party can accept the initiating party’s preferred certified IDR entity or object and propose another certified IDR entity.

A lack of response from the non-initiating party within 3 business days will be deemed to be acceptance of the initiating party’s preferred certified IDR entity.

If the non-initiating party objects to your IDR entity within the 3 business days, they will choose their desired IDR Entity.

You will receive an email that day granting you 1 day to respond whether you agree with the non initiating party’s selection of an IDR entity or not. If you do not agree with the non initiating party’s IDR entity you may choose your preference of another IDR entity. CMS will give your selection weight but is not binding.

If the parties do not agree on a certified IDR entity, the Departments will randomly select a certified IDR entity on the parties’ behalf. If random selection is necessary, the Departments will make the selection no later than 6 business days after IDR initiation.

In sum, Claimant and the non initiating party will both have the opportunity be able to choose an IDR entity and disqualify the opposing IDR entities choice. If such happens CMS will randomly select an entity for the case.

Certified IDR Entity Requirements

Once the IDR is selected, the certified IDR entity must submit an attestation that it does not have a conflict of interest and determine whether the Federal IDR Process is applicable, within 3 business days, thereby finalizing the selection.

Once the IDR Is selected, you will receive and email from the ID entity stating that your submission of Offer and Payment is due. You will have 10 business days to submit your final offer and pay both Fees: The IDR Entity Fee and administrative Fee.

*Note: Please be advised that arbitration proceedings are conducted solely based on submitted documents. This entails that the arbitrator has access only to the documents provided by both parties; there are no oral arguments, depositions, interrogatories, or discovery processes. Any information or arguments intended for the arbitrator's consideration must be included in the submitted documents for review and ultimate decision-making.

By choosing Advanced Arbitration Claimant will pay one payment and we will then forward the administrative fee to CMS simplifying your IDR Process.

A certified IDR entity has 30 business days from the date of finalization of its selection to determine the payment amount and notify the parties and the Departments of its decision. The certified IDR entity must select one of the offers submitted.

This means arbitration is baseball style arbitration, the arbitrator is forced to either choose your final offer or the non initiating parties Offer. It cannot choose any number in between. It is forced to choose one or the other.

Any amount due from one party to the other party must be paid not later than 30 calendar days after the determination by the certified IDR entity. The certified IDR entity must refund the prevailing party’s certified IDR entity fee within 30 business days after the determination.

Please click this link for a more comprehensive outline detailing and explaining the IDR timeline and PDF Detailing the entire IDR Process.