A favorable determination is not the final reconciliation step.

Record the determination as its own event.

The operating record should preserve the determination date, selected offer, affected items or services, certified IDR entity, fees, and relevant notices. For grouped matters, retain the item-level outcome rather than only a batch-level status.

Track payment separately.

A determination and cash received are different events. Create a payment-due date, monitor remittance activity, and record the amount and date actually paid. Partial payments, mismatched claim references, and unexplained adjustments should route to an exception queue.

Reconcile incremental recovery.

PRP defines incremental recovery as the amount ultimately paid minus the amount originally paid. The dashboard should preserve both source amounts and distinguish an issued determination from a completed recovery.

Escalate noncompliance through the appropriate channel.

CMS provides a provider complaint path for potential noncompliance with the federal IDR process or No Surprises Act protections. The correct response depends on the specific facts, plan, dispute, notices, and current agency instructions.

PRP’s public materials do not promise collection of an award or replace legal advice. Client agreements should separately address post-determination responsibilities and fee treatment.

Close the file with a complete audit trail.

• Determination and payment records
• Amounts originally paid, determined, and ultimately received
• Open exceptions and follow-up communications
• Incremental-recovery calculation
• Final status and closure date