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The Federal IDR timeline in plain language
This summarizes how CMS describes the process on its website (page last modified September 15, 2026).
- Open negotiation: a 30-business-day period starts after a payment denial notice or initial payment for certain out-of-network services.
- Initiation: if there is no agreement, either party may start IDR within 4 business days after the open negotiation period ends, unless the Departments extend the deadline.
- Choosing an entity: the parties choose a certified IDR entity from the certified list and attest to having no conflicts of interest.
- Offers: each side submits a payment offer and supporting information to the entity.
- Decision: the entity selects one of the two offers, and both parties must abide by the decision.
- Payment: within 30 calendar days of the decision.
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 says the process will move from single-use web forms to the IDR Gateway in late 2026.
Source: CMS: payment disputes between providers and health plans. This page is not legal advice.