Can a certified IDR entity also file disputes for providers?

No. Certified IDR entities must be independent of both parties, and conflict of interest rules disqualify an entity from deciding a dispute involving a party it has a relationship with. Deciding disputes and filing them are mutually exclusive roles.

Who certifies IDR entities?

The federal departments that administer the No Surprises Act certify IDR entities, and CMS publishes the current roster. Certification requires demonstrated expertise, conflict of interest safeguards, and fee schedules within government-approved ranges.

Do I pay the IDR entity?

Both parties deposit the entity's fee, a few hundred dollars per dispute, when the case is filed. The winner gets its deposit back and the loser's deposit pays the entity, so a winning provider's net entity cost is zero.

Answers / Companies vs entities

IDR companies vs IDR entities: who does what

An IDR company is a vendor a provider hires to run No Surprises Act arbitration: eligibility, deadlines, filings, and offers. A certified IDR entity is the arbitrator, an organization certified by the federal government to decide disputes, paid through refundable deposits from both parties. You can hire the first. You can never hire the second.

Two names that sound the same

The No Surprises Act created a process called independent dispute resolution and an official role called the certified IDR entity. The market then grew a layer of vendors who file those disputes for providers, and everyone started calling them IDR companies. The vocabulary collision is unfortunate because the two roles could not be more different: one is your advocate, the other is the referee, and the law forbids mixing them.

What an IDR company does

An IDR company works your side of the dispute. It screens claims for eligibility, sends open negotiation notices inside the 30 business day window, initiates arbitration within the 4 business day deadline when negotiation fails, builds the payment offer and the evidence behind it, and chases the payment that is due within 30 calendar days of a win. Some are software, some are filing services, some are law firms. They are paid by you, under whatever agreement you signed, most commonly a percentage of recovery or, in the case of Lido IDR, a flat fee per arbitration.

What an IDR entity does

A certified IDR entity decides the dispute. The federal government certifies these organizations, publishes the roster on the CMS No Surprises Act site, and requires them to be independent: an entity with a conflict of interest, say a business relationship with either party, cannot take the case. FHAS, C2C Innovative Solutions, and Medical Evaluators of Texas are among the highest-volume entities in the published record. The entity reviews both offers against the statutory factors and must pick one offer in full, and its fee, a few hundred dollars set within government-approved ranges, is deposited by both sides and refunded to the winner.

How the entity gets picked

After a provider initiates a dispute, the parties have 3 business days to jointly agree on a certified IDR entity. If they cannot agree, the government assigns one at random. That is the whole relationship: neither side interviews the arbitrator, builds rapport, or works with it across disputes the way they would with a vendor. If a sales pitch implies influence over which entity decides your cases or how it rules, the pitch is describing something the No Surprises Act prohibits.

Hire a side, not the referee

Lido IDR screens, files, and argues your No Surprises Act disputes for a flat fee per arbitration, with the published record behind every offer. Talk to an IDR specialist.