Federal IDR guides
Federal IDR, explained in plain English.
Thirteen short answers to the questions provider groups ask most. Each one is checked against the federal rule and the 2025 CMS Public Use Files, with the sources at the bottom.
Rules as of September 2026 · Data from 2025 Q1–Q4 · Air ambulance excluded
How the process works
The rules, the clock, the money, and how the entity decides.
Guide
How long do I have at each step of federal IDR?Every federal IDR deadline in one table, with business days vs calendar days and what starts each clock. Plus the one window that kills claims.Read the guide Guide
Is this claim eligible for federal IDR?Six questions decide whether an out-of-network claim can go to federal IDR. Plain answers, a plan-type table, and where it goes if the answer is no.Read the guide Guide
What is the QPA, and how is it calculated?The qualifying payment amount is the payer's own benchmark. How it is built, what the payer must disclose, and what the August 2026 court ruling changes.Read the guide Guide
Which claims can go in one IDR dispute?Four tests decide whether claims can be batched into one federal IDR dispute. What batching saves, the traps, and what changes on November 1, 2026.Read the guide Guide
What does federal IDR cost, and who pays?Two fees: $15 to CMS and an IDR entity fee of a few hundred dollars. Who pays each, what comes back if you win or settle, and what June 2026 changed.Read the guide Guide
Does this claim go to federal IDR or the state?Self-funded plans usually go federal. Fully insured plans go federal in 28 states plus DC, and to a state process in 21. Two steps to sort a claim.Read the guide Guide
What goes in the open negotiation notice?The notice that starts the federal IDR clock. What it must contain, how to send it, the deadline, and what changes when the 2026 rules go live.Read the guide Guide
What does the IDR entity actually weigh?The IDR entity must pick one offer. What it must consider, what it cannot, and what 5.4 million 2025 decisions say about how offers play out.Read the guide Decisions
Whether to file, who should file, and what it should cost.
Guide
Should we run federal IDR in house or outsource it?Most groups can win IDR in house. Few can file every claim that deserves it. What the cost per dispute does to recovery, and what to ask a vendor.Read the guide Guide
Contingency fee or platform fee: which is better for IDR?IDR vendors charge a share of what they recover, or a fee per dispute. What each costs, what each rewards, and the question to ask before you sign.Read the guide Guide
What does a bad IDR submission cost?The entity picks one offer, so the number is the submission. What a low ask, a high ask with nothing behind it, and a sloppy packet each cost you.Read the guide Guide
Why do IDR disputes close as ineligible?About one in six federal IDR disputes ever filed was thrown out as ineligible. The checks that catch it before you pay the fees, and why payers make them hard.Read the guide Guide
When should you not file for federal IDR?Three cases where filing is the wrong call, the math for everything else, and why the answer changes once the cost per dispute drops.Read the guide The numbers behind the guides
The outcome figures come from our own build of the 2025 CMS files, the same one behind our state and payer pages. IDR by state, IDR by payer, and the methodology show how each number is counted.
Your data, not the national average
See how your group's IDR record compares.
A free report card built from the same CMS files, measured at the group level. Nothing needed from you.