Federal independent dispute resolution
Potentially eligible out-of-network items or services nationwide under the No Surprises Act after an unsuccessful open-negotiation period.
Explore Federal supportCMS federal IDR guidanceCurrent service coverage
Nationwide federal IDR plus four supported state pathways.
Federal IDR may apply to eligible claims nationwide. New York, New Jersey, Florida, and Texas are PRP’s currently supported state-specific pathways—not limits on federal coverage.
New York state IDR
New York maintains a state process for qualifying payment disputes involving emergency services and surprise bills under state-regulated coverage.
Explore New York supportNew York DFS guidanceNew Jersey state pathways
New Jersey pathway analysis depends on the plan, dispute type, state requirements, and the federal-state allocation of authority.
Explore New Jersey supportNew Jersey DOBI bulletinFlorida claim dispute resolution
Florida maintains a statewide provider and health-plan claim dispute program for matters within the governing statute and agency process.
Explore Florida supportFlorida Statutes § 408.7057Texas mediation and arbitration
Texas uses mediation for certain facility disputes and arbitration for certain out-of-network provider disputes, subject to plan and timing rules.
Explore Texas supportTexas Department of InsurancePathway review
The state name is only the beginning.
Federal IDR is not limited to the four states listed here. Eligibility and routing can depend on the plan, funding arrangement, claim facts, date, venue, service, payer response, and procedural timing. PRP confirms the likely pathway before work begins; this guide is not an eligibility determination.
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