What happens after an IDR decision and when payment is due
Payment of an IDR award is due 30 calendar days after the determination, under 45 CFR 149.510(c)(5)(ix). The decision is binding, so the work after it is calculating the amount, posting the payment and collecting if the date passes.
Written by Salman Saeed, CEO and Co-Founder · Reviewed by a Certified Medical Coder · 
In short: the selected amount, less the initial payment and cost sharing, is due within 30 calendar days of the determination. The decision is binding, the administrative fee is not refunded and a new dispute on the same item waits.
What happens after the IDR entity decides?
The certified IDR entity sends both parties and the Secretary a written decision, and the selected amount is due within 30 calendar days of the determination. Four other things follow: fee refunds, a pause on new disputes, the patient balance and your own posting work.
The decision must explain which information showed that the chosen offer best represents the value of the item or service, including the weight given to the QPA and any other credible information (45 CFR 149.510(c)(5)(vi)). Save that decision with the claim. It is the document you will use if the money is late.
| What | Deadline or rule | Source |
|---|---|---|
| Payment of the selected offer, less initial payment and cost sharing | 30 calendar days after the determination | 149.510(c)(5)(ix) |
| Repayment by the provider if the offer is lower than the initial payment plus cost sharing | 30 calendar days after the determination | 149.510(c)(5)(ix) |
| Return of the prevailing party's entity fee | Within 30 business days of the payment determination | 149.510(d)(1)(iii) |
| Pause on a new dispute for the same item or service, single determination | 90 calendar days after the determination | 149.510(c)(5)(vii)(B) |
| Entity record retention | 6 years | 149.510(c)(5)(viii) |
When is payment due after an IDR decision?
Payment is due 30 calendar days after the determination, and the count includes weekends and holidays. Section 149.510(c)(5)(ix) says the amount of the selected offer, less the sum of the initial payment and any cost sharing paid or owed by the participant, must be paid directly to the provider or facility within that time.
The count starts from the determination, not from the day you read the email. Use the decision date shown on the written decision. The NSA deadline calculator counts the business day deadlines earlier in the dispute, and the payment date is a plain calendar count from there.
A determination is issued on Tuesday, January 12, 2027. The entity selects the provider's offer of $1,200. The plan already paid $300 as the initial payment, and the patient's cost sharing is $150.
What if the selected offer is lower than what the plan already paid?
The provider or facility owes the plan the difference, also within 30 calendar days of the determination. Section 149.510(c)(5)(ix) says the provider is liable to the plan or issuer if the offer selected is less than the initial payment plus cost sharing paid by the participant.
Put that date on your calendar the day the decision arrives. A repayment missed by a billing team that was waiting for good news is an avoidable error. In a batched dispute, check each line item against its own initial payment, because the decision may favor each side on different lines.
Is an IDR decision final, and can you appeal it?
The decision is binding. Under 149.510(c)(5)(vii)(A), a determination is binding on the parties in the absence of fraud or evidence of intentional misrepresentation of material facts, and it is not subject to judicial review except in a case described in paragraphs (1) through (4) of 9 U.S.C. 10(a). There is no appeal to CMS.
The practical effect is that the work that decides the result is the offer and the documents you send before the decision. After it, your job is collection and posting. Other posts cover how to choose your offer and how entities weigh the evidence.
What happens to the fees you paid?
The administrative fee is not refunded. The certified IDR entity fee is treated differently: the entity keeps the non-prevailing party's fee and must return the prevailing party's fee within 30 business days of the payment determination (149.510(d)(1)(iii)). The entity fee rule applies to disputes initiated on or after August 3, 2026.
In a batched dispute where each party prevails in an equal number of determinations, the fee is split evenly and the entity returns half of each party's fee. Check that the refund arrives and post it against the dispute, because it is easy to leave in the clearing account. The $15 administrative fee is covered on the IDR operations rule page.
Can you start another dispute on the same item right away?
Not against the same other party for the same item or service. After a single determination, the party that started the dispute cannot submit a new IDR request involving the same other party for the same item or service for 90 calendar days (149.510(c)(5)(vii)(B)).
For batched disputes whose open negotiation begins on or after November 1, 2026, the wait is 30 business days after the determination. Single and bundled disputes keep the 90 calendar day wait. The rule also lets either party start a dispute in a window after the pause if open negotiation ended during it, so track the end of the pause for claims still in negotiation.
What should billing do in the 30 days after a decision?
How we handle it
We handle out-of-network reimbursement end to end, from outcome tracking and deadline management to payment reconciliation under federal IDR and applicable state pathways. Our out-of-network billing and IDR service fits emergency medicine billing groups that want every award tracked to cash. Book a call to review your open decisions. More posts are on the blog.
- 45 CFR 149.510 Independent dispute resolution process · eCFR
- About Independent Dispute Resolution · CMS
- Federal Independent Dispute Resolution Operations (final rule, 91 FR 33900) · Federal Register
We check every rule, code and deadline against the official source. See our editorial policy.
Common questions
Straight answers from the team that does the work.
Ask a billing lead directly. A 20-minute call, Monday to Friday, 9am to 5pm Eastern.
01What happens after an IDR decision and when is payment due?
The entity sends a written decision to both parties and the Secretary. The selected offer, less the initial payment and cost sharing, must be paid directly to the provider or facility within 30 calendar days of the determination under 45 CFR 149.510(c)(5)(ix). The prevailing party's entity fee comes back within 30 business days.
02Is the IDR payment due in business days or calendar days?
Calendar days. Payment of the selected offer is due not later than 30 calendar days after the determination, so weekends and holidays count. The return of the prevailing party's entity fee is the one that runs in business days, 30 of them after the payment determination.
03Can a provider appeal an IDR decision?
There is no appeal to CMS. The decision is binding absent fraud or evidence of intentional misrepresentation of material facts, and it is not subject to judicial review except in the cases listed in 9 U.S.C. 10(a)(1) through (4). Plan your effort around the offer and documents you submit before the decision.
04What if the IDR entity picks the payer's lower offer?
If the selected offer is less than the initial payment plus the patient's cost sharing, the provider or facility owes the plan the difference. It must pay it directly to the plan or issuer within 30 calendar days of the determination. Check each line in a batch against its own initial payment.
05Can I start a new IDR dispute right after a decision?
Not for the same item or service against the same other party. After a single determination, the initiating party must wait 90 calendar days. For batched disputes with open negotiation starting on or after November 1, 2026, the wait is 30 business days after the determination.
Talk to a billing lead.
A 20-minute call about your payers, volume and setup. Monday to Friday, 9am to 5pm Eastern.