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.

The blank CSV keeps the determination, matched payments, unresolved difference, and next action in separate fields. Use one row per disputed item and update its payment summary as receipts are matched. Keep the dated correspondence and individual receipt history in your secure case file; the worksheet points to those records.

Download the blank payment worksheet (CSV)

• Use an internal reference without patient identifiers. Keep patient names, dates of birth, member numbers, and clinical details out of this worksheet.
• Confirm the balance basis before entering an expected payment. The file contains no formula or deadline calculator.
• Record fees and refunds in a separate ledger and reference that record. Keep expected refunds separate from refunds received.
• Name a follow-up owner and next check date. A payer’s statement that payment was issued still needs a matching remittance and receipt.

The CSV downloads directly. There is no upload step. Store the completed file only in your organization’s approved system.

Worksheet and payment-tracing source check: October 12, 2026. See the CMS process overview and submission and communication guidance.

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.

A payment-trace request to adapt

For dispute [reference], our records show the determination notified on [date] and an unresolved payer amount of [amount], based on [brief reconciliation]. Please confirm whether payment has been issued. If so, provide the issue date, amount, payment trace or check reference, and the corresponding remittance through our agreed secure channel. Please identify the claim items covered and any offsets. If payment has not been issued or you disagree with this balance, please explain the reason and next step in writing.

Replace the placeholders only after checking the account. Use the payer’s approved channel and include only the identifiers needed to locate the dispute. This example is a tracing request, not an official complaint or a legal demand.

CMS’s provider billing complaint page gives the official channel for reporting suspected noncompliance with the federal IDR process or No Surprises Act protections. It links to the online complaint form and the No Surprises Help Desk at 1-800-985-3059. Confirm the appropriate route for your issue before submitting.

Prepare the records for a complaint review

Use the records below to prepare a factual account, then check the documents requested by the official channel for your issue. CMS says supporting documentation may be required; the Help Desk can clarify what to provide and check a complaint’s status.

1. Final determination: locate the decision, notification date, dispute reference, parties, and affected claim items. Confirm the final document and which payment requirement applies.
2. Claim and payment record: gather the relevant explanation of benefits, remittances, matched receipts, and a reconciliation of the unresolved difference. Keep initial payments, later payments, fees, and uncertain offsets separate. The reconciliation guide helps organize that review.
3. Earlier payment-trace requests: retain the dated request, payer responses, any issue date or payment reference supplied, and your biller’s matching result. Include the explanation for an unresolved partial payment or offset when available.
4. Factual summary: record what remains unresolved, the relevant dates, and the source for each amount. Identify missing records and unanswered questions. Have the authorized follow-up owner review the account and proposed complaint before submission.
5. Submission copies: retain originals in the approved case file and prepare only the documents the destination requests. Follow the official channel’s privacy instructions. Confirm requested identifiers and any redactions with the Help Desk before preparing attachments.
6. Permissions and follow-up: confirm authority to provide the information. After an authorized submission, retain the confirmation and reference number in the secure case file, with the owner and next follow-up action.

The CMS instructions and complaint link are the place to check current document requests and submission steps. Keep patient information out of the blank planning worksheet on this page; submit any required claim records only through the official channel under its instructions.

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.

Provider complaint channel and public CMS guidance checked October 12, 2026. The record groups above are suggested preparation steps; confirm required attachments with CMS for your issue.

• 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.