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    IDR Process Overview

    MedRes turns federal IDR requirements into a disciplined workflow for eligibility review, open negotiation, evidence, filing, determination, and payment follow-up.

    Timing reference: CMS federal IDR overview. Verify current instructions and any Department-granted extensions for each matter.

    1

    Initial Review & Analysis

    We analyze your out-of-network EOBs and claims to determine eligibility for IDR dispute and potential recovery value.

    Key Activities:

    • EOB and claim documentation review
    • Payment amount vs. fair market analysis
    • IDR eligibility assessment
    • Recovery potential calculation
    2

    Open Negotiation Period

    Before formal IDR, we manage the required 30-business-day negotiation period with insurers to seek a payment resolution.

    Key Activities:

    • Formal negotiation initiation
    • Evidence-based payment arguments
    • Insurer communication management
    • Documentation of all interactions
    3

    IDR Initiation & Filing

    If negotiation fails, we initiate federal IDR during the four-business-day window and coordinate certified IDR entity selection.

    Key Activities:

    • IDR entity selection and filing
    • Comprehensive case documentation
    • Payment amount justification
    • Supporting evidence compilation
    4

    Evidence Preparation

    We build compelling cases using clinical merit, provider qualifications, market rates, and complexity factors.

    Key Activities:

    • Clinical complexity documentation
    • Provider credential compilation
    • Market rate benchmarking
    • Supporting evidence organization
    5

    Arbitration & Resolution

    The IDR entity reviews both positions and selects one payment amount. Amounts due are generally payable within 30 calendar days after determination.

    Key Activities:

    • Case presentation to arbitrator
    • Response to insurer arguments
    • Final decision monitoring
    • Payment collection and follow-up

    Our IDR Success Principles

    • Comprehensive case documentation and evidence compilation
    • Strategic IDR entity selection based on case specifics
    • Clinical merit emphasis with physician-backed expertise
    • Rigorous deadline management and compliance tracking
    • Transparent communication throughout the entire process