Tips for Disputing Parties

Helpful tips and tools for initiating an IDR dispute

Before initiating a dispute utilizing the Federal IDR process, please review the following resources and read through the common mistakes and best practices outlined below in order to ensure that your dispute is processed as quickly and efficiently as possible.

Webinars and system demonstrations

• YouTube playlist: No Surprises Act Independent Dispute Resolution

Instructions and tips for IDR web forms

• IDR Notice of Initiation Web Form Job Aid (PDF)
• Certified IDR Entity Selection Web Form Job Aid (PDF)
• IDR Notice of Offer Web Form Job Aid (PDF)

Timeline requirements

• IDR Timeline for Claims (PDF)
• The Notices section for any current extensions

Applicability of Federal IDR process in each state

• Chart for Determining the Applicability of Federal IDR Process (PDF)

Comprehensive guidance documents

• Federal IDR Guidance for Certified IDR Entities (December 2023 Update to October 2022 Guidance) (PDF)
• Federal IDR Guidance for Disputing Parties (December 2023 Update to March 2023 Guidance) (PDF)
• The Overview of Rules & Fact Sheets page for all other guidance documents   

Common mistakes
To ensure your dispute is processed as quickly as possible, please try to avoid these common mistakes:

• Submitting disputes that are subject to a specified state law or All-Payer Model Agreement and are therefore not eligible for the Federal IDR process.  
• Incorrectly batching or bundling multiple items or services.
• Failure to use the contact information provided with the initial payment or notice of denial of payment.
• Failure to include the Qualifying Payment Amount (QPA) provided with the initial payment or notice of denial of payment.
• Failure to provide accurate health plan type for the submitted dispute.
• Failure to provide the complete and correct information for the non-initiating party. 
• Failure to provide documentation of initiation of open negotiation, if the non-initiating party reports that open negotiation did not occur.
• Failure to redact protected health information (PHI) and personally identifiable information (PII) from documentation before submitting. 
• Failure to submit information in response to a certified IDR entity’s request in a timely manner. 

Communications

• Check your spam folder for emails from FederalIDRQuestions@cms.hhs.gov. If necessary, contact your IT department to add this email to your "safe senders" list to avoid spam blocking.
• Provide the certified IDR entities, the Federal IDR portal, and other parties to your disputes with contact information for the individual responsible for receiving and responding to communications, and update contact information when it changes.
• Ensure that you have correct contact information for the other party to your dispute. If necessary, contact the other party to verify contact information before beginning the dispute. Using incorrect contact information can lead to delays in processing. 
  • If you have difficulties getting the information you need from the other party, file a complaint or contact the the Departments at FederalIDRQuestions@cms.hhs.gov.

Submitting a complete dispute initiation

• Ensure that your dispute initiation is complete. The following items are frequently missing and will cause delays in processing:
  • Correct and complete contact information for the non-initiating party.
  • The claim number of the items or services for which you’re disputing payment.
  • A complete Explanation of Benefits (EOB).
  • The QPA for the items or services being disputed.
• We encourage parties to upload the following items to the Federal IDR system during initiation to ensure disputes move through the process efficiently: 
  • Complete copy of remittance or notice of denial of payment for the disputed item or service, with appropriate codes.
  • Documentation, such as copies of emails sent to the non-initiating party, to demonstrate initiation of the required 30-business-day open negotiation period.
  • An email from a certified IDR entity requesting that a previously submitted dispute be resubmitted with corrections to batching errors (if applicable).
  • An email that can serve as evidence of an extension being granted (if applicable).

Submitting fees

• Once you have selected a certified IDR entity, be sure to check on its requirements for submitting administrative fees and certified IDR entity fees and submit them accordingly.
• If you do not pay your administrative and certified IDR entity fees, your offer will not be reviewed.

Getting help

• Send questions to the Federal IDR mailbox at FederalIDRQuestions@cms.hhs.gov.
• Contact the No Surprises Help Desk at 1-800-985-3059 from 8 a.m. to 8 p.m. ET, 7 days a week, to ask questions or to report any potential violations of the process.