Independent Dispute Resolution (No Surprises Act)

Submit the following for each disputed line item:

• Accurate Contact Information: Complete contact details for both the initiating and non-initiating parties.
• Open Negotiation Documentation (if applicable): Full Open Negotiation Notice, documentation sent to the other party, and proof of delivery with date.
• IDR Notice of Initiation (if applicable): Documented proof sent to the Non-Initiating Party (NIP) and when.
• Initial Payment or Notice of Denial: Complete copy including all corrected versions, remark codes, explanations, and contact information.
• Claim Forms: All applicable claim forms including original and corrected forms.
• Member Visit Documentation (if applicable): All PHI and PII must be redacted before submitting.
• NSA Eligibility Documentation (if applicable): Insurance cards, remittance advice, EOB, cooling-off period proof, etc.
• NSA Eligibility Objections (if applicable): Must include supporting documentation — failure to provide may result in a determination that the dispute is eligible.
• Cooling-Off Period Documentation (COP) (if applicable): Payment Determination letter that triggered the COP, health plan type, and member's group number for both disputes.
• Missed Timeline Documentation (if applicable): Evidence the dispute qualified as an exception, including proof explaining why a deadline was missed.
• Qualifying Payment Amount (QPA): The QPA applicable to the disputed item or service.
• Health Plan Documentation: Health plan type, group numbers, applicable policies, insurance cards, and plan terms.
• Notice of Offer Form (NOOF): Both parties have 10 business days from the NOOF link date to submit their offer. Legal briefs or position statements may also be submitted.

Per CMS, the most common mistakes to avoid include:

• Submitting disputes subject to a specified state law or All-Payer Model Agreement that are not eligible for Federal IDR.
• Incorrectly batching or bundling multiple items or services.
• Failure to use the contact information provided with the initial payment or notice of denial.
• Failure to include the Qualifying Payment Amount (QPA).
• Failure to provide an accurate health plan type for the submitted dispute.
• Failure to provide complete and correct information for the non-initiating party.
• Failure to document initiation of open negotiation, if the non-initiating party reports it did not occur.
• Failure to redact PHI and PII from documentation before submitting.
• Failure to submit information in response to a certified IDR entity's request in a timely manner.

1. Review your documentation carefully. Submit all objections and support materials when filing the IDR Notice of Initiation Form or the Certified IDR Entity Selection Response Form, or within 3 business days after the entity requests additional information.
2. Save copies of uploaded documents. CMS instructs parties to download system-generated files at the time of submission.
3. Upload initial documentation through the CMS portal. Use your party's exact name when accessing the dispute.
4. Submit additional information through the iMPROve Health Federal IDR portal. After filing, submit any additional documentation through your iMPROve Health account using your party's exact name.

Promptly upload all requested materials through the iMPROve Health Federal IDR portal. An iMPROve Health account is required.

• If you already have an account, log in and submit using your party's exact name.
• If you do not have an account, sign up at the iMPROve Health Federal IDR portal, then log in and submit once created.

Contact iMPROve Health at FederalIDRE@improve.health. Always include your IDR dispute name/number in your request.

• Batched Disputes: Multiple related items or services combined into a single IDR case — same patient encounter, same service codes, or same Category I CPT code group.
• Bundled Disputes: Services billed as part of a bundled payment arrangement (e.g., a DRG), or when a plan or issuer makes or denies an initial bundled payment for one member.

A dispute must meet all four key conditions and at least one batch dispute type criterion to qualify.

Four Key Conditions

• Items/services billed by the same provider or facility with the same NIP or Tax ID.
• Payment made by the same plan or issuer.
• Items/services are the same or similar.
• All furnished within the same 30-business-day period, or the same 90-calendar-day cooling-off period.

Batch Dispute Type Criteria — meet at least one

• Single Patient Encounter/Episode of Care: Services furnished to one patient during the same visit, billed on the same claim with same or consecutive dates of service.
• Identical Service Codes: Items/services share the exact same billing code across multiple claims.
• Category CPT Code Section: Services fall within the same CPT code category group.

Bundling occurs when qualified IDR items and services for one member are billed by a provider, facility, or air ambulance service provider as part of a bundled payment arrangement (e.g., a DRG), or when a plan or issuer makes or denies an initial bundled payment. The qualified IDR items and services may be submitted together as one dispute for a single payment determination.

Some states enforce their own balance billing laws and have their own surprise billing arbitration process. If the SSL or APMA applies, it will affect whether a dispute qualifies for the Federal IDR process under the No Surprises Act.

Parties should review CMS state-by-state resources and the Chart for Determining the Applicability for the Federal Independent Dispute Resolution (IDR) Process to determine which process applies.

When a settlement is reached, notify both the certified IDR entity and the Departments by emailing FederalIDRQuestions@cms.hhs.gov and FederalIDRE@improve.health. Include:

• The agreed-upon total out-of-network rate, including patient cost-sharing and the health plan payment.
• The method used to allocate the IDR entity fee if not split evenly.
• A written settlement agreement signed by authorized representatives of both parties.

Email FederalIDRE@improve.health with the dispute name/number and reason for withdrawal. Both parties must provide written consent (email or signed letter) before we can process a withdrawal.

Upon withdrawal, CMS retains the administrative fee, and each party remains responsible for half of the certified IDR entity fee.

First, review the CMS guidance: Dispute Closure Error Technical Assistance (6-6-2025) to determine whether the dispute qualifies. Then, email iMPROve Health at FederalIDRE@improve.health and include:

• The IDR dispute name/number.
• The error category and reason you believe the request to reopen should be granted.
• Any relevant information or documentation that supports your request.

• Check your spam or junk folders regularly for emails from FederalIDRQuestions@cms.hhs.gov.
• Provide accurate contact information to all dispute-related parties and update it as needed.
• Verify the contact information for the non-initiating party before starting the dispute.
• If the other party is unresponsive, file a complaint with CMS or email FederalIDRQuestions@cms.hhs.gov.

Key CMS Resources

• CMS No Surprises overview and fact sheets
• CMS Federal Portal and IDR process guidance
• Notice of IDR Initiation Form User Guide
• IDR Notice of Initiation Form
• Certified IDR Entity Selection Response Form
• Federal IDR Notice of Offer Web Form
• Requirements Related to Surprise Billing: Final Rules
• No Surprises Act IDR Process Proposed Rule Fact Sheet
• Standard Notice and Consent Documents Under the No Surprises Act