Process Guidance
Federal IDR Open Negotiation Guide
Operational steps, required forms, and tracking controls for the mandatory 30-business-day open negotiation period under the No Surprises Act.
Before either party can initiate the Federal Independent Dispute Resolution (IDR) process, they must complete a mandatory 30-business-day open negotiation period. The goal of this period is to allow the provider and the health plan to agree on a final payment amount without requiring arbitration.
1. The 30-Business-Day Initiation Window
A provider must initiate open negotiation within 30 business days beginning on the day the provider receives the initial payment or a notice of denial of payment for the item or service. If you miss this deadline, you forfeit the right to access the Federal IDR process for that claim.
2. Required Notice and Documentation
To officially start the open negotiation period, you must send a compliant Open Negotiation Notice to the health plan. This notice must include:
- Information sufficient to identify the items or services (including date of service, billing codes, and claim numbers).
- The provider's or facility's initial offer for the out-of-network rate.
- Contact information for the party initiating the negotiation.
Note: Always use the most current standard federal form provided by CMS.
3. The 30-Business-Day Negotiation Period
Once the notice is sent, the 30-business-day open negotiation period begins. During this time, both parties may exchange offers and counteroffers. It is critical to maintain a meticulous, dated log of all correspondence.
Evidentiary Controls
If negotiations fail, you will need to prove to the certified IDR entity that you initiated open negotiation properly and on time. Retain delivery receipts (e.g., email read receipts, certified mail tracking, or portal confirmations) and all counteroffers received.
4. What Happens if Negotiations Fail?
If no agreement is reached by the end of the 30-business-day period, the initiating party has a strict 4-business-day window to escalate the claim by initiating the Federal IDR process.