Elevating Healthcare with Independent Dispute Resolution for Enhanced Care
What Is Independent Dispute Resolution (IDR)?
How the IDR Process Works
Open Negotiation Period
When an out-of-network payment is denied or underpaid, the provider (or facility) and the health plan begin a 30-business-day open negotiation period.
Initiating the IDR Process
If both parties are unable to reach an agreement within the negotiation period, either party can initiate the IDR process within 4 business days after the negotiation period ends.
Certified IDR Entity
Once the IDR process begins, both the provider and the health plan select a certified IDR entity from the official list of approved organizations to independently review the dispute.
Submitting Payment Offers
Each party then submits their proposed payment amount, along with all relevant documentation and supporting details, to the chosen IDR entity for review.
Final Decision
The IDR entity evaluates the information from both sides and selects one of the submitted payment offers. This decision is final and legally binding, and the payment must be made within 30 calendar days of the determination.
Extenuating Circumstances
If unforeseen or exceptional circumstances prevent either party from meeting the required deadlines, an extension may be requested by providing valid justification to the IDR entity.
The IDR process ensures that patients remain protected from payment disputes, while providers and payers benefit from a clear, fair, and structured resolution path. At Zytramed Solution, we help healthcare organizations navigate this process efficiently — promoting fairness, compliance, and continuity of care.