What is the cooling-off period after an IDR determination?
Verdict Consulting Group Research · Updated
Answer
The cooling-off period is the 90 calendar days after an IDR payment determination during which the initiating party cannot file a new dispute against the same party over the same or a similar item or service. Claims whose open negotiation ends in that window can be submitted within 30 business days after it closes.
Detail
How it works
| Determination type | Suspension period | Source |
|---|---|---|
| Single determination | 90 calendar days | 42 U.S.C. 300gg-111(c)(5)(E)(ii); 45 CFR 149.510(c)(5)(vii)(B) |
| Batched determination | 30 business days | 45 CFR 149.510(c)(5)(vii)(B), as amended by 91 FR 33900 |
The suspension binds only the party that initiated the first dispute, and only against the same other party. Items whose open negotiation period ends during the suspension are not lost: the statute lets them be submitted after it ends (42 U.S.C. 300gg-111(c)(5)(E)(iii)).
CMS's implementation guide lists the cooling-off period for batched disputes among the batching provisions that apply to disputes with open negotiation periods starting on or after November 1, 2026.
Why it matters for eligibility
CMS reports that since the fourth quarter of 2024, an incomplete cooling-off period has been one of the most frequent reasons certified IDR entities found disputes ineligible.
Sources
- Legal Information Institute, Cornell Law School — 42 U.S. Code § 300gg-111 — Preventing surprise medical bills ()
- Electronic Code of Federal Regulations — 45 CFR 149.510 — Independent dispute resolution process ()
- Centers for Medicare & Medicaid Services — Supplemental Background on Federal IDR Public Use Files, July 1 – December 31, 2025 ()
General information only, not legal advice. Verdict Consulting Group is not a law firm.