The average Independent Dispute Resolution (IDR) timeline takes approximately 120 days from start to finish, though complex cases can significantly exceed this. While the No Surprises Act (NSA) strictly mandates a 30-business-day window for the arbitrator’s decision, systemic backlogs mean providers should prepare for a multi-month process.
One of the major issues that New Jersey medical patients have faced over the last two decades is the lack of transparency in medical billing. To combat balance billing, the federal government passed the No Surprises Act (NSA) in 2022.
If your medical practice was underpaid, delayed, or denied commercial insurance reimbursement, your claim may be eligible for federal IDR arbitration. Healthcare providers win approximately 86% of IDR disputes. However, the process relies on rigid timelines—miss a single deadline, and you lose your right to dispute. Contact Kotlar Cohen NSA arbitration attorneys. Don’t miss your IDR deadline — talk to an attorney.
We have been helping healthcare providers navigate unfair IDR arbitrations since the NSA was enacted.
Independent Dispute Resolution Arbitrations
When a surprise medical bill occurs, the provider and the health plan must negotiate the final payment rate for the service. The complete IDR process guide is a required process under the NSA used to settle any payment disagreements. IDR is a form of third-party arbitration where a qualified expert determines the appropriate reimbursement amount the payer must remit to the provider.
Under the NSA, the IDR is subject to strict statutory guidelines that must be adhered to. Below is a summary of the IDR process and timeline:
Step 1: Initial payment – The process begins with the initial payment by the insurance company.
Step 2: Open negotiation (30 business days) – The IDR process begins with 30 days during which the payer and provider attempt to negotiate a resolution for the outstanding medical bill. A large percentage of disputes will end up being resolved during this process as the IDR process is inherently uncertain due to the nature of the process. Many times, neither party wants to take the financial risk associated with an arbitrator’s decision that is out of its control.
Step 3: Notification Period (4 business days) – If negotiation fails, the initiating party must file for the federal IDR process within four business days of the negotiation period ending.
Step 4: IDR entity selection (3 days) – The NSA requires that both the provider and the insurer jointly select an IDR entity within a three‑business‑day window after dispute initiation. The initiating party will be the first to select an IDR entity, and the non-initiating party will then have the right to accept or reject that entity. If both parties agree on the entity, the process is complete. However, if the parties cannot agree within the 3-day period, the federal agencies (HHS, Treasury, and Labor) randomly select an IDR entity from the list of certified organizations. To be certified, an IDR entity must demonstrate expertise in:
- Arbitration and claims administration
- Managed care
- Billing and coding
- Health care law
Step 5: Offer submission (10 business days) – Once in the process, both parties submit a final, binding offer to the selected IDR entity. The entity then engages in a “baseball-style” arbitration, selecting one of the two final offers. Baseball-style arbitration means that the two sides each submit an amount to the arbitrator, and the arbitrator will select one of the two amounts. The arbitrator is not authorized to modify or split the difference. The process encourages parties to submit reasonable and realistic offers, as extreme positions risk outright rejection.
Step 6: Arbitration decision (30 business days) – Adherence to these strict timelines is essential, as the statute requires the IDR entity to issue a payment determination within 30 business days of its selection, which helps stabilize payment cycles for covered services.
Step 7: Payment (30 business days) – The IDR entity’s determination is legally binding. Once the IDR entity has made a decision and notified the parties, the losing party — the one whose offer was not selected — must pay the difference owed within 30 calendar days of the determination. This deadline cannot be extended. The losing party is also responsible for the full IDR fee.
Total Typical Timeline For the IDR Process
The volume of disputes initiated under the IDR process quickly dwarfed initial federal estimates as soon as the program became operational. The program’s initial estimate of approximately 17,000 annual disputes was rapidly surpassed, with providers initiating over a million disputes by the end of 2024.
This high volume created a substantial backlog and caused significant delays in payment determinations. To address the issue, the federal government implemented operational improvements. Due to these efforts, as of July 2025, a significant 96.5% of all submitted IDR disputes were either resolved or less than 30 business days old, demonstrating marked progress in clearing prior backlogs.
The average IDR timeline is approximately 120 days. The entire process can easily far exceed that timeline. The following factors have also contributed to a delay in the IDR process:
- Eligibility challenges – Determining whether a dispute qualifies for federal IDR is complex and time-consuming, and nearly 40% of disputes are challenged as ineligible.
- Litigation – Challenges to the IDR regulations have produced significant processing and other delays.
- Communication gaps – Providers are often not sure whether a claim is eligible for NSA protections. Without standardized codes and remittance advice remarks, parties may submit ineligible disputes, leading to unnecessary IDR involvement and delays
- Systemic operational bottlenecks – The initial IDR framework, with its 30‑day open negotiation period and arbitration step, was not designed for the scale of submissions. The sheer number of cases, combined with the need for eligibility checks, arbitration, and post‑arbitration appeals, has strained the system
- Administrative issues – Certain rules regarding dispute initiation have been sources of confusion and delays. Parties have been forced to navigate these to avoid procedural rejections or to ensure a timely IDR arbitration timeline
In June 2026, the Health and Human Services, Labor, and Treasury Departments (the Departments) issued a Final Rule updating the rules governing the IDR process. One of the stated goals of the Final Rule is to dramatically speed up the process by forcing earlier information exchange and tightening procedures before disputes reach arbitration. It remains to be seen if the Final Rule will accomplish this goal, or if the process will continue to have operational and timing issues.
FAQs
Q: What is the deadline to initiate an IDR?
Q: What happens if I miss the IDR filing window?
Q: How long does the NSA IDR process take?
Q: Can IDR deadlines be extended?
Q: Why is my IDR case taking so long?
Call Kotlar Cohen Today With Your IDR Arbitration Issues
Kotlar Cohen has been at the forefront of the IDR arbitration timeline since the NSA was passed in 2022. We work tirelessly for our medical provider clients to ensure you are fairly paid for the services which you provide. The insurance companies will have attorneys representing them at arbitration: You should too. Contact Kotlar Cohen today to represent you in your IDR proceeding.