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After you initiate: the clocks
- Pick the entity: 3 business days. The parties agree on a certified IDR entity within 3 business days after initiation. Silence from the other party counts as agreement.
- Or the Secretary picks: 6 business days. If the parties have not agreed, the Secretary selects an entity within 6 business days after initiation.
- Offers: 10 business days after the entity is selected.
- Decision: 30 business days after the entity is selected.
- Payment: 30 calendar days after the determination.
- Cooling-off: 90 calendar days. After a determination, the initiating party may not start another dispute against the same party for the same or similar items or services for 90 calendar days. The amended rule shortens this to 30 business days after a batched determination once its new provisions apply.
If the parties agree on a rate after initiation but before the entity decides, the initiating party notifies the Departments and the entity within 3 business days (CMS).
Sources: 45 CFR 149.510(c) and (c)(4)-(5) on eCFR; CMS payment disputes page. Read 2026-10-17. Business days exclude weekends and federal holidays. Not legal advice.