Federal IDR glossary.Short definitions for the terms billing teams see most.
Plain language definitions for the terms billing teams actually encounter. Each entry links to the guide that owns the full explanation.
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Terms
Administrative fee
A non refundable fee each party pays when initiating federal IDR, set annually by CMS. It is $15 per party, per dispute, cut from $115 by the final rule of May 28, 2026, effective June 11, 2026. It is separate from the IDRE fee, which the losing party generally bears after the determination.
Batching
Grouping similar claims into one IDR dispute to lower per claim administrative cost. CMS sanctioned batching as of the May 28, 2026 final rule. For high value surgical claims, batching can make several codes win or lose together on one arbiter offer. Sydra defaults to one claim per CPT and lets your team decide per submission.
Business day
A weekday used for federal IDR clocks. Open negotiation runs 30 business days, and the initiation window that follows is 4 business days. These counts are business days, not calendar days, and they do not extend once they start.
CMS Federal IDR Public Use File (PUF)
CMS published files that summarize resolved federal IDR disputes under the No Surprises Act. The benchmark win rates and award multiples on this site are sourced from these Public Use Files and related analyses, and describe the federal record across all filers. Sydra's own client outcomes are published separately and labelled as Sydra figures, so the two are never read as the same number.
Contingency fee
A fee model that typically keeps 20 percent or more of every recovery. The share does not shrink as your volume grows, so the cost rises with every successful dispute while the work per dispute does not. Sydra is priced on per claim and subscription models rather than a percentage of recovery.
Cooling off period
A 90 calendar day wait after an adverse determination before the same code and payer combination can be re filed. Sydra tracks cooling off status so your team knows when a combination becomes eligible again.
Cost sharing
Under the No Surprises Act, the patient pays only their in network cost share for qualifying out of network care. The health plan and the provider settle the rest between themselves, which is where most payment disputes begin.
Federal IDR portal
The CMS hosted system where providers and plans initiate disputes, select arbitrators, exchange offers and evidence, and receive determinations. It is the system of record for every step of a federal No Surprises Act dispute.
Fully insured
A traditional plan where the employer buys coverage and the insurer bears the risk. Fully insured disputes may route to a state surprise billing process in states that have one, instead of federal IDR.
Georgetown CHIR
Georgetown University CHIR analyses of CMS Federal IDR Public Use Files. Site figures such as the about 88 percent provider win rate through the first half of 2025 cite Georgetown CHIR alongside CMS source files.
IDR
Independent Dispute Resolution. The federal arbitration process under the No Surprises Act that settles out of network payment disputes between providers and health plans when open negotiation does not resolve the claim.
IDR initiation window
The 4 business day period after open negotiation closes in which a party must initiate federal IDR through the portal. Miss that window and the claim is closed for that cycle. There is no general grace period.
IDRE
Independent dispute resolution entity. A certified arbitrator that receives both parties' final offers and evidence, then selects one offer. The IDRE cannot invent a third number or split the difference.
No Surprises Act
Federal law that protects patients from many surprise medical bills and creates the federal IDR process for qualifying out of network payment disputes between providers and plans.
Open negotiation
A required 30 business day period to try to settle a payment dispute directly with the plan before IDR can begin. Either party starts it by sending an Open Negotiation Notice. Most disputes do not settle here, but the period cannot be skipped.
Prior determination
A prior IDR award or written decision on a comparable code, geography, or service. Market rate justifications cite prior determinations so the arbitrator can weigh the provider's offer against real outcomes, not only the plan's qualifying payment amount.
QPA
Short for qualifying payment amount. The plan's median contracted rate for a service in a geographic area. It is the insurer's starting anchor in an IDR dispute, not a cap on the award. Arbitrators weigh it against other evidence and are not required to pick the QPA.
Self funded
An employer plan where the employer pays claims directly and uses an insurer only to administer them. Self funded plans are governed by federal law and route to federal IDR in every state.
Sourced references
- 1. CMS Federal IDR Q1/Q2 2025 Public Use FileReleased January 21, 2026cms.gov/nosurprises/policies-and-resources/reports
- 2. CMS Federal IDR Q4 2025 Public Use FileQuarter 4, 2025. Source for the per CPT area average initial payment and median figures in the Practice A table on the homepage. Geography and median denominator are pending confirmation from ops; see the TODO above PRACTICE_A in src/lib/content/homepage.ts.cms.gov/nosurprises/policies-and-resources/reports
- 3. Sydra client records, presented with client permissionProvenance for the Sydra performance figures in SYDRA_PERFORMANCE (src/lib/idr/proof-points.ts): 92% across 113 decided cases, 82.9% across 76 decided cases under the client's prior contingency firm, and the CPT 19318 award of $50,742.00 against a $2,500 QPA. Decided cases only; excludes withdrawn, ineligible, and pending disputes. Not federal data and not a category benchmark.
- 4. Georgetown University CHIR · Health Affairs webinarMarch 2026. 3.4 million disputes through June 2025; 88% win rate; median award ~4.5x in network rate
- 5. Zelis: NSA IDR Eligibility ChallengesMarch 2026. 44% of 2024 IDR cases challenged as ineligible by non initiating party
- 6. ACEP analysis of CMS data~10% of eligible claims estimated to reach IDR arbitration
- 7. Brookings Institution NSA Arbitration DatabookApril 2026brookings.edu/articles/no-surprises-act-arbitration-databook
- 8. ACR: Providers Prevail in Vast Majority of IDR ClaimsJanuary 2026. 88% of disputes found in provider's favor; 87% of awards exceeded QPA
- 9. No Surprises Act: Public Law 116-260, Division BB, Title I
- 10. Federal IDR regulations: 45 CFR Part 149ecfr.gov/current/title-45/subtitle-A/subchapter-F/part-149
- 11. CMS No Surprises Act overviewcms.gov/nosurprises
- 12. HHS HIPAA for professionalshhs.gov/hipaa/for-professionals
- 13. CMS Final Rule: No Surprises Act IDR overhaul (HHS, DOL, Treasury, OPM)Administrative fee reduced from $115 to $15. Batching of multiple claims now permitted to lower costs and speed resolution. New IDR Gateway centralized platform rolling out in phases.cms.gov/newsroom/press-releases/federal-rule-takes-aim-saving-taxpayer-dollars-health-care-bureaucracy-reducing-dispute-fees
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