How does the No Surprises Act Independent Dispute Resolution (IDR) process work?

When a provider and health plan cannot agree on the payment amount for a covered out-of-network service, either party may initiate the federal Independent Dispute Resolution (IDR) process. In IDR, a certified independent dispute-resolution entity acts as an arbitrator and, after the parties submit their proposed payment amounts, selects one of the two offers. This is a “baseball-style” or final-offer arbitration: the arbitrator picks one side’s number rather than splitting the difference. The arbitrator weighs a set of statutory factors, including the qualifying payment amount — the plan’s median in-network rate for the service, indexed for inflation — among other considerations. The decision is binding on the payment dispute.