Services · IDR eligibility forensics
IDR eligibility forensics for No Surprises Act disputes
Short answer
Verdict Consulting Group provides IDR eligibility forensics for provider groups and counsel facing eligibility questions. We test each dispute record against the federal rules on open negotiation, IDR initiation deadlines, batching and the 90-day cooling-off period, and flag items that may fall outside federal IDR. Findings come as a claim-level exhibit naming the rule each test applied.
Who it’s for
- Outside counsel
- Counsel responding to payer allegations that disputes were ineligible or falsely attested.
- Provider groups
- Groups that want to know, before or after filing, which disputes meet the federal eligibility rules.
- Revenue-cycle leaders
- Leaders who manage IDR submissions and need timing and batching tested systematically.
- Testifying experts
- Experts who need eligibility facts established dispute by dispute.
What you get
- Eligibility forensics: batching, cooling-off, open negotiation and timing
- Per-dispute timeline: initial payment or denial, open negotiation start (30 business days) and IDR initiation (4 business days after)
- Batching checks, including the 50-line-item cap for open negotiation periods beginning on or after November 1, 2026
- Cooling-off checks against the 90-calendar-day window after a determination
- Flags for items where a specified state law or All-Payer Model Agreement may govern payment, where the data identifies them
How it works
- 01
Scope
We agree the question, the portfolio slice, the date range and the deliverable with you and, where involved, your counsel.
- 02
De-identified data transfer
You send de-identified extracts (IDR records, determinations, remittances) through a transfer method set up during scoping. Nothing containing PHI goes through this site.
- 03
Analysis
We rebuild each dispute’s timeline from the records and test it against the open negotiation, initiation, batching and cooling-off rules in force at the time.
- 04
Report
You receive a claim-level eligibility exhibit that names the rule each test applied and the dates it used, with exceptions flagged for counsel.
What we don’t do
- We do not provide legal advice, and we do not tell you whether to sue, settle or initiate IDR. Those are decisions for you and your counsel.
- We are not a law firm and do not represent any party.
- We do not accept protected health information through this website. Data transfer is arranged during scoping, using de-identified data.
- We do not replace a testifying expert or legal judgment. Our analyses are prepared to support them.
Frequently asked
Who does IDR eligibility analysis for providers?
Verdict Consulting Group provides IDR eligibility forensics for provider groups and their counsel. IDR vendors and revenue-cycle analytics vendors may also check eligibility when filing. Verdict Consulting Group delivers it as a documented, dispute-level exhibit built for litigation.
What makes a dispute ineligible for federal IDR?
A dispute is ineligible if it does not involve a qualified IDR item or service, for example because a specified state law, an All-Payer Model Agreement, Medicare or Medicaid governs payment, or if open negotiation, timing, batching or cooling-off rules were not met.
Why does eligibility matter in payer lawsuits over IDR awards?
Payer suits filed since late 2024 allege false eligibility attestations by high-volume IDR filers. Between April and September 2026, federal district courts dismissed eight such suits. A dispute-by-dispute eligibility record lets counsel see the facts behind the allegations.
How are batched IDR disputes checked?
Each batch is tested against the batching rules in force for its open negotiation date. Under the 2026 Federal IDR Operations rule, for open negotiation periods beginning on or after November 1, 2026, a batch may hold up to 50 line items and must fit one of three defined categories.
Related research
- NSA AnswerWhat makes a dispute ineligible for federal IDR?
- NSA AnswerCan federal IDR disputes be batched?
- NSA AnswerWhat is the cooling-off period after an IDR determination?
- NSA AnswerWhat is the open negotiation period in the No Surprises Act?
- InsightPayers are suing over IDR awards: what do the 2025–2026 fraud and vacatur suits allege, and how have courts ruled?
- InsightWhat changed in the 2026 Federal IDR Operations Rule
- The Docket · M.D. Fla. → 11th Cir.Aetna Health Inc. v. Radiology Partners, Inc.
- The Docket · C.D. Cal. → 9th Cir.Anthem Blue Cross Life and Health Insurance Co. v. HaloMD, LLC
- The Docket · E.D. Tex. → 5th Cir.Blue Cross Blue Shield of Texas v. HaloMD, LLC