Independent Dispute Resolution
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Patient receives services from an out-of-network provider.
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Health plans must make an initial payment or provide a notice of denial to the out-of-network provider within 30 days from when the service was rendered.
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After 30 days, the provider can initiate a 30-day open negotiation process.
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If after 30 days, the parties do not come to a negotiation, either party has four days to initiate the IDR process by notifying the other party.
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The parties have three days to choose an IDF entity.
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Within ten days, the parties must each provide a best offer.
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The IDR will choose one of the offers. The payer has 30 days to reimburse the provider.