Claims for services rendered on or after January 1, 2022 may be eligible for the federal IDR process, depending on the following factors:
Type of health plan – Eligibility varies based on whether the claim is submitted to a self-funded or fully-funded insurance plan.
Service location – Some states have their own IDR processes, which may take precedence over the federal IDR system, making certain claims ineligible.
Timing – The IDR process follows strict deadlines. Claims must be submitted within a specific timeframe after the insurer’s initial payment, or they may no longer qualify for federal IDR.
