Most federal IDR disputes that fail don’t fail on the merits. They fail on the calendar. The No Surprises Act process runs on short, fixed windows. Most are counted in business days, and missing one generally ends the dispute before an arbitrator ever sees your offer.
This guide walks through each deadline in order.
Business days, not calendar days. Unless stated otherwise, federal IDR deadlines count business days: Monday through Friday, excluding federal holidays. A “30-day” window is roughly six weeks on the calendar.
At a glance
| Step | Deadline | Clock starts |
|---|---|---|
| Initial payment or denial | 30 calendar days | Plan receives the clean claim |
| Start open negotiation | 30 business days | You receive the initial payment or denial |
| Open negotiation period | 30 business days | The open negotiation notice is sent |
| Initiate federal IDR | 4 business days | Open negotiation period ends |
| Select the IDR entity | 3 business days | IDR is initiated |
| Submit offers and fees | 10 business days | IDR entity is selected |
| Determination | 30 business days | IDR entity is selected |
| Payment of any amount owed | 30 calendar days | Determination is issued |
1. The plan’s initial payment or notice of denial
For a qualified out-of-network claim, the plan or issuer must send an initial payment or a notice of denial within 30 calendar days of receiving a clean claim. That response should include the plan’s qualifying payment amount (QPA) for each item or service. See our QPA guide for what to check.
The date you receive this payment or denial starts the next clock. Record it.
2. Starting open negotiation: 30 business days
If you disagree with the amount, you have 30 business days from receiving the initial payment or denial to send an open negotiation notice to the plan. Use the standard notice published by the Departments.
Open negotiation is not optional. It is a precondition of federal IDR. A claim that never went through open negotiation cannot be taken to IDR. See our open negotiation guide.
3. The open negotiation period: 30 business days
The negotiation period runs 30 business days from the date the notice is sent. Either side can settle at any point. If you reach agreement, that amount is the out-of-network rate and the dispute ends.
4. Initiating federal IDR: 4 business days
If the negotiation period ends without agreement, either party can initiate federal IDR within 4 business days after it ends. That means filing through the Federal IDR portal and sending the notice of IDR initiation to the other party.
This is the tightest window in the process and the one most often missed. Practices that track open negotiation in a spreadsheet commonly find the period ended the week before.
5. Selecting the certified IDR entity: 3 business days
The initiating party proposes a certified IDR entity (IDRE) in its notice. The other party has 3 business days to agree or object. If the parties don’t jointly select an entity, the Departments assign one at random.
The non-initiating party may also raise eligibility objections at this stage, such as a claim that the dispute belongs in a state process. The IDRE decides eligibility before moving on to the offers.
6. Offers and fees: 10 business days
Once an IDRE is selected, each party has 10 business days to submit:
- its offer: a single final payment amount for each item or service, and
- any supporting information it wants the IDRE to consider, and
- the required fees. There is a non-refundable administrative fee, and the IDRE’s fee, which is refunded to the party whose offer is selected.
Federal IDR is “baseball-style”: the IDRE must pick one of the two offers. It cannot split the difference. That makes the quality of the supporting documentation decisive.
7. The determination: 30 business days
The IDRE must issue its written determination within 30 business days of being selected. The determination is binding on both parties, with narrow exceptions such as fraud.
8. Payment: 30 calendar days
If the IDRE selects an offer that requires further payment, that payment is due within 30 calendar days of the determination. Track this date too. A favorable determination is only worth something once the payment actually arrives.
9. The 90-day cooling-off period
After a determination, the party that initiated the dispute cannot bring a new IDR dispute against the same party for the same item or service for 90 calendar days. Claims whose open negotiation ends during that period aren’t lost. They can be submitted during a limited window after the cooling-off period ends.
End to end: how long does it take?
Adding up the windows, a claim that goes all the way to a determination typically takes around four to six months from the initial payment. It can take longer when there are eligibility disputes, IDRE backlogs or delayed payment. Many claims settle during open negotiation, well before that.
Keeping it on track
- Log every “clock-starting” date the day it happens: remit received, notice sent, IDR initiated, IDRE selected, determination issued.
- Count business days with a holiday calendar. A single missed federal holiday can put a filing a day late.
- Check eligibility before initiating. The administrative fee isn’t refunded if the dispute is found ineligible. See the pre-filing checklist.
- Verify against current guidance. The Departments update IDR operations periodically. Confirm the current rules at cms.gov/nosurprises before relying on any deadline.
This guide is general information, not legal advice.