Independent Dispute Resolution
Patient receives services from an out-of-network provider.
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.
After 30 days, the provider can initiate a 30-day open negotiation process.
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.
The parties have three days to choose an IDF entity.
Within ten days, the parties must each provide a best offer.
The IDR will choose one of the offers. The payer has 30 days to reimburse the provider.