How do provider groups track unpaid IDR awards?
Verdict Consulting Group Research · Updated
Answer
By logging each federal IDR determination, setting a payment due date 30 calendar days later, and matching remittances against it. Awards still unpaid or short-paid after that date go on an aging report by payer and plan. Unpaid awards can be reported to the No Surprises Help Desk; whether a provider can sue depends on the court.
Detail
The tracking record
| Field | Why it matters |
|---|---|
| Determination date | Starts the 30-calendar-day payment clock under 45 CFR 149.510(c)(5)(ix) |
| Amount owed | Selected offer, less the initial payment and patient cost sharing |
| Due date | 30 calendar days after the determination |
| Payments received | Amount and date of each remittance matched to the award |
| Status | Paid, short-paid, late or unpaid, aged by payer and plan |
What happens to awards that stay unpaid
CMS directs parties to the No Surprises Help Desk to report potential violations. Court routes are divided: the Fifth and Second Circuits hold there is no private right of action to enforce IDR awards. See What happens if a health plan does not pay an IDR award?.
Verdict Consulting Group offers IDR award payment tracking for provider groups and their counsel.
Sources
- Electronic Code of Federal Regulations — 45 CFR 149.510 — Independent dispute resolution process ()
- Centers for Medicare & Medicaid Services — About Independent Dispute Resolution ()
- Verdict Consulting Group — IDR award payment tracking for provider groups and counsel ()
General information only, not legal advice. Verdict Consulting Group is not a law firm.