A certified independent dispute resolution (IDR) entity is an organization certified by the federal Departments of Health and Human Services, Labor and the Treasury to decide payment disputes in the federal IDR process under the No Surprises Act. Certification is for organizations that can show the experience, staffing and controls to decide cases fairly and impartially. Integral Healthcare Solutions (IHS) builds your IDR entity's policies and evidence file against the federal certification requirements and drafts the application text you submit.
Last reviewed: October 2026.
What is federal IDR entity certification?
Federal IDR entity certification is governed by the certification standards at 45 CFR 149.510(e), with parallel Labor and Treasury rules, and by the CMS "Apply to be certified" application page. The regulation states: "An IDR entity must meet the standards described in this paragraph (e) and be certified by the Secretary, jointly with the Secretaries of Labor and the Treasury" (45 CFR 149.510(e)(1)(i)).
CMS describes the application this way: "Organizations interested in being certified to conduct arbitration in the independent dispute resolution process will need to apply online and submit documentation to show they have the experience and staffing to adjudicate cases fairly and impartially" (CMS, Apply to be certified). CMS also states that "The application process opened September 30, 2021, and will remain open to accept applications on a rolling basis" (same page).
Certification carries continuing obligations. "An IDR entity that the Secretary, jointly with the Secretary of Labor and the Secretary of the Treasury, certifies must enter into an agreement as a condition of certification" (45 CFR 149.510(e)(1)(iii)), and "each certification (including a recertification) of a certified IDR entity under the process described in paragraph (e)(1) of this section will be effective for a 5-year period" (45 CFR 149.510(e)(4)).
Who needs it and what triggers it
Certification is for organizations that intend to decide disputes in the federal IDR process. CMS lists the expertise an applicant must show: "Arbitration and claims administration Managed care Billing and coding Medical Legal (including healthcare law)" (CMS). An applicant also chooses its geographic scope: "IDR entities may choose to submit their application for all States or self-limit to a particular subset of States" (45 CFR 149.510(e)(1)(ii)).
The work usually starts with one of these events:
- Program formation. An organization decides to enter the federal IDR process and has to assemble the policies, staffing evidence and controls the application asks for.
- Recertification. Certification runs for five years, including a recertification (45 CFR 149.510(e)(4)), so a certified entity rebuilds its evidence on that cycle.
- A material change. New ownership, new reviewers, a new subcontractor or a change in states served alters the evidence behind the certification.
- A petition. "An individual, provider, facility, provider of air ambulance services, plan, or issuer may petition for a denial of a certification for an IDR entity or a revocation of a certification for a certified IDR entity for failure to meet a requirement of this section" (45 CFR 149.510(e)(5)(i)). Current, organized evidence is what an entity relies on when that happens.
How IHS helps
IHS works through a fixed process against 45 CFR 149.510(e) and the CMS document list:
- Gap assessment. Questionnaires on ownership, conflicts of interest and staffing show what the organization already has and what is missing.
- Document and evidence mapping. IHS builds a coverage map from each certification element in the regulation and each item on the CMS list to the evidence that answers it.
- Drafting. IHS drafts the conflict-of-interest, independence, confidentiality, records, subcontractor oversight and decision-process policies, assembles a staffing evidence file, and drafts the application text, all for your leadership and counsel to review and approve.
- Mock review. IHS runs a rehearsal review of the full file against the regulation and the CMS list before anything is entered.
- Readiness support. IHS keeps an open-items list until every document the application needs is final.
What your organization supplies: corporate and ownership records, reviewer credentials, conflict disclosures, your counsel for legal interpretation, and your business-model decisions, such as which states to serve.
The limit: IHS is not counsel and does not file. Your organization files the application; IHS drafts the text. The Departments decide certification and its timing.
Related IHS pages: Program Development, Compliance Services, and the separate page on the URAC Independent Dispute Resolution designation, which is a URAC program, not federal certification.
What to have ready
CMS warns: "You’ll need to have all of your documents ready and you won’t be able to save your work" (CMS). Each item below comes from the CMS document list on that page or from 45 CFR 149.510(e).
- Organization structure and staffing plan (CMS document list).
- Conflict of interest attestation (CMS document list).
- Indicators of fiscal integrity (CMS document list).
- Internal controls to hold fees (CMS document list).
- Fee schedule (CMS document list).
- Proof of accreditation or arbitration training (CMS document list).
- Process to maintain the confidentiality of individually identifiable health information (CMS document list).
- Internal controls to support reporting compliance (CMS document list).
- Policies and procedures for ensuring subcontractor compliance (CMS document list).
- Evidence of expertise in arbitration and claims administration, managed care, billing and coding, medical, and legal including healthcare law (CMS).
- A decision on whether to apply for all states or a subset (45 CFR 149.510(e)(1)(ii)).
When the list is together, the introductory call is the place to start.
How it compares
Organizations considering federal IDR work usually weigh these routes.
| Route | What the sources say | What to weigh |
|---|---|---|
| Apply directly, without outside help | CMS offers the online application and states the form cannot be saved, so documents must be ready first (CMS). | Internal staff time to build the policies and evidence file. |
| Meet expertise and staffing through contracts with others | The regulation lets an entity meet expertise and staffing "directly or through contracts or other arrangements" (45 CFR 149.510(e)(2)). | Subcontractor oversight policies are on the CMS document list (CMS). |
| Accreditation or arbitration training as evidence | The CMS list includes "Proof of accreditation or arbitration training" (CMS). | The pages we reviewed do not say which accreditations CMS accepts. |
| IHS policy build and evidence file | Drafted policies, coverage map, staffing evidence file, rehearsal review and drafted application text. | Your organization still files, and counsel still interprets the law. |
What it costs
CMS does not publish an application or certification fee for IDR entities on the pages we reviewed; your costs depend on scope. The fees CMS does publish are dispute-level fees. CMS describes a December 21, 2023 final rule under which "the administrative fee amount charged by the Departments to participate in the Federal IDR process, and the ranges for certified IDR entity fees for single and batched determinations, will be established by the Departments in notice and comment rulemaking" (CMS rules and fact sheets). The same CMS page adds: "This rule also sets the amount of the administrative fee and the certified IDR entity fee ranges for disputes initiated on or after January 22, 2024." Verify current fees with CMS. IHS scopes each engagement after a free introductory call.
What this is not
- This page is not legal advice. IHS is not a law firm and does not interpret the No Surprises Act for you; your counsel does.
- IHS does not file the application or correspond with CMS or the Departments for you. Your organization files; IHS drafts the text.
- IHS does not guarantee certification. The Departments decide certification and its timing.
Frequently asked questions
What is a certified IDR entity under the No Surprises Act?
It is an organization certified to decide payment disputes in the federal independent dispute resolution process. Under 45 CFR 149.510(e)(1)(i), an IDR entity must meet the standards in that paragraph and be certified by the Secretary of Health and Human Services jointly with the Secretaries of Labor and the Treasury.
Who can apply to become a federally certified IDR entity?
CMS states that organizations interested in being certified must apply online and submit documentation showing they have the experience and staffing to adjudicate cases fairly and impartially. CMS says the application process opened September 30, 2021 and remains open on a rolling basis.
What expertise must an IDR entity show?
CMS lists expertise in arbitration and claims administration, managed care, billing and coding, medical, and legal including healthcare law. The regulation allows an entity to meet expertise and staffing directly or through contracts or other arrangements.
What documents does the CMS IDR certification application require?
CMS lists the organization structure and staffing plan, conflict of interest attestation, indicators of fiscal integrity, internal controls to hold fees, fee schedule, proof of accreditation or arbitration training, the confidentiality process for individually identifiable health information, internal controls for reporting compliance, and subcontractor compliance policies. CMS also states the application cannot be saved, so every document should be ready first.
How long does federal IDR certification last?
Under 45 CFR 149.510(e)(4), each certification, including a recertification, is effective for a 5-year period. The evidence file therefore has to be kept current for the next cycle.
Can an IDR entity limit its certification to certain states?
Yes. 45 CFR 149.510(e)(1)(ii) states that IDR entities may choose to submit their application for all States or self-limit to a particular subset of States. That choice is a business decision your leadership makes before the application is drafted.
What happens if someone petitions to deny or revoke our certification?
45 CFR 149.510(e)(5)(i) allows an individual, provider, facility, provider of air ambulance services, plan or issuer to petition for denial or revocation of a certification for failure to meet a requirement of that section. How to respond to a petition is a question for your counsel. IHS keeps the policies and evidence behind the certification organized and current.
What does a certified IDR entity agree to as a condition of certification?
Under 45 CFR 149.510(e)(1)(iii), a certified IDR entity must enter into an agreement as a condition of certification. Your counsel reviews the agreement's terms. IHS drafts the operating policies the entity uses to meet them.
How do certified IDR entity fee ranges work, and who sets them?
CMS states that a December 21, 2023 final rule moved future changes to the administrative fee and certified IDR entity fee ranges into notice and comment rulemaking and set the amounts for disputes initiated on or after January 22, 2024. Verify current fees with CMS. Your fee schedule is also on the CMS application document list.
How long does it take to prepare an IDR entity application?
CMS does not publish a preparation or processing time on the pages we reviewed. Preparation time depends on how many of the listed documents already exist and how many reviewers need credential and conflict evidence. IHS sets a timeline with you after the introductory call.