This is a slightly edited version of a chart that appeared in CMS’s Oct. 7 interim final regulation.[1]
Independent Dispute Resolution Process
Step in the Process |
Must Be Completed By |
---|---|
1. Payer sends provider initial payment or notice of denial of payment (also sends qualifying payment amount) |
30 business days Starting on day payer receives all relevant data |
2. Provider initiates 30-business-day open negotiation period |
30 business days Starting on day of initial payment or notice of denial of payment |
3. Either party initiates IDR process following failed negotiations |
4 business days Starting business day after the open negotiation period ends |
4. Mutual agreement on certified IDR entity selection; each party pays $50 administrative fee |
3 business days After IDR initiation date |
5. Feds select IDR entity if no agreement by parties |
6 business days After IDR initiation date |
6. Parties submit payment offers to IDR entity |
10 business days After date of certified IDR entity selection |
7. Payment determination made; loser pays IDR entity fee |
30 business days After date of certified IDR entity selection |
8. Payment completed |
30 business days After payment determination |