Federal IDR guides
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.
Verified September 11, 2026
Short answer
Since the process began, 17.8% of closed federal IDR disputes were closed as ineligible. In June and July 2026 it was 14.7%. That is a dispute that got filed, paid its fees, waited, and was thrown out without a decision.
The entity fee normally comes back. The $15 CMS fee does not, whatever the outcome. The time does not come back either, and the claim is usually dead by then, because the deadlines have passed.
Ineligible, Jun to Jul 2026
14.7%
Of closed disputes
Ineligible, program to date
17.8%
Of closed disputes
Closed in those two months
671,465
Disputes
Thrown out in those months
98,398
Disputes
The numbers
| Period | Closed disputes | Closed ineligible | Share |
|---|---|---|---|
| June to July 2026 | 671,465 | 98,398 | 14.7% |
| Program to date | 6,527,388 | 1,163,219 | 17.8% |
CMS publishes the count. It does not publish a reason you can sort by. So nobody outside CMS knows the exact mix.
The usual reasons
From the rule and from what we see across our own filings, disputes are thrown out for a short list of reasons.
| Reason | What went wrong |
|---|---|
| Wrong process | The plan is fully insured in a state with its own process, so federal IDR does not apply |
| Late | The open negotiation notice or the IDR filing missed its window |
| No negotiation | The notice was never sent, or cannot be proven |
| Not a surprise bill | In-network claim, patient consented to out-of-network care, or a service the law does not cover |
| Bad batch | Lines in one dispute that fail the batching tests |
| Already filed | The same items were filed before and the cooling-off period has not passed |
| Wrong party | Filed against the administrator, not the plan |
Almost all of these can be checked before you file. Most of them can be checked before you send the notice.
Why it is hard
The facts you need sit with the payer. Whether the plan is self-funded. Whether it is a plan the law covers. Whether the payer already treated the claim as a surprise bill. Whether a state process applies.
Payers do not always send that with the payment. They are supposed to. Many do not. When you ask, the answer can take weeks, and the clock does not stop.
What to check, in order
The remittance. The 835 or paper EOB. Look for the QPA, the surprise-billing flag, and the plan type.
The claim itself. The HCFA or UB. Place of service, codes, and whether the service is one the law covers.
The plan. Cross-check the group number against what you know about the plan. Self-funded or fully insured. Federal or state.
The payer portal. Many payers list plan funding there when they will not put it on the EOB.
The phone. When the paper does not settle it, call the payer and write down who said what and when.
Do this before the notice goes out. The notice is the start of the clock.
Recourse
Where Recourse fits
Recourse runs these checks on every claim before it files. Software reads the 835s, EOBs and claim forms, matches the plan against our own database of payers and plans, and checks payer portals. When that does not settle it, our operations team calls the payer. A claim that will not survive eligibility never pays a fee.
Sources
CMS, Federal IDR Process Status Update, June and July 2026 (bimonthly report); 45 CFR 149.510(a) and (b); CMS Federal IDR Guidance for Disputing Parties. Program-to-date closures are determinations plus ineligible plus other closures as reported by CMS.
Every number on this page comes from public CMS files or the federal rule. Our methodology explains how we count. Questions? sales@recoursehealth.com
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