When an IDR award
has not been paid.

Pull the final determination and check the dispute number, parties, services, selected offer, and notification date. Make sure you have the final decision, not a status email or settlement proposal.

CMS states that payment under the federal IDR determination must be made within 30 calendar days. Verify the applicable requirement against the determination and current guidance; do not assume a state proceeding or separate settlement follows the same process. Read the CMS federal process overview.

Choose one person to handle follow-up and give them access to the determination. Ask the biller whether payment has arrived under a different claim reference or remittance before reporting nonpayment.

Compare the determination with the initial payment, later remittances, and posted deposits. Do not add the full selected offer to prior payments without first confirming how the determined rate and amounts already paid relate.

• Separate a missing payment from an unposted payment.
• Record partial receipts and identify the items they cover.
• Keep administrative fees, entity fees, and service fees separate from payer reimbursement.
• Mark uncertain allocations as unresolved instead of treating them as confirmed shortfalls.

Keep the payment history and follow-up notes together in your secure case file. The checklist below is a suggested working record; use the official form if you later submit a complaint.

Store claim and patient information in the practice’s approved systems. Use only the information needed for the destination and follow its security and redaction instructions.

Give the payer the dispute reference and ask whether payment has been issued. If it has, request the date and remittance or payment reference so your biller can find it. If the payer disputes the amount, ask for the reason in writing.

Before anyone follows up, have the practice, biller, and IDR partner agree on the balance and the records supporting it. If the answer arrives by phone, note the date, who you spoke with, and what they said.

CMS’s disputing-party guidance lists the No Surprises Help Desk at 1-800-985-3059 for questions and potential process violations, and links to the official complaint channel. Follow the instructions for the specific issue and keep any reference number.

A complaint is not a promise of payment or a substitute for case-specific legal advice. If the practice is considering enforcement or another legal remedy, ask qualified counsel to assess the facts, available route, deadlines, and costs. This guide makes no conclusion about judicial enforceability.

• Who checks remittances and confirms that funds were received?
• Who contacts the payer, and where is the correspondence retained?
• Who can authorize a complaint or legal consultation?
• Does the service agreement include post-determination follow-up?
• How will the practice be told that payment is received or the issue remains unresolved?

Keep the determination, expected payment, and money received in separate fields. When you close the issue, record what resolved it and where the supporting document is stored.