Pathway overview
Start with the governing plan and claim facts.
The federal independent dispute resolution process may be available nationwide for certain out-of-network items and services when a provider or facility and a health plan cannot agree on payment after the required open-negotiation period. The plan, service, date, notice, and timing all matter.
Important distinctions
What provider teams should identify early.
- Federal IDR is a nationwide federal pathway; it is not limited to New York, New Jersey, Florida, or Texas.
- The process addresses payment between disputing parties; it is not a patient billing workflow.
- A 30-business-day open-negotiation period generally precedes federal IDR initiation.
- Plan regulation and any applicable state process must be reviewed before selecting the federal pathway.
PRP operating scope
One managed workflow from review through outcome.
- 01
Review the plan, service, payment or denial, notices, and procedural timing.
- 02
Confirm the likely federal or state pathway before initiating work.
- 03
Manage negotiation notices, filing steps, deadlines, and communications.
- 04
Organize client-supplied records into a clear supporting submission.
- 05
Track status, outcomes, and incremental recovery in the client dashboard.