IDR & the NSA For provider groups
The 90-Day Cooling-Off Period: The IDR Rule That Catches Providers Off Guard
Short answer: once a certified IDR entity decides a dispute, you generally can’t open a new dispute against the same plan for the same or similar item or service for 90 calendar days. It’s one of the eight federal IDR eligibility criteria — and providers who don’t track it get disputes dismissed for a reason that has nothing to do with the merits.
What the period covers
The bar is narrow on purpose. It applies to:
- the same two parties, and
- the same or a similar item or service.
It does not block disputes for different services, or disputes against a different plan. The goal is to stop immediate re-litigation of the same matter — not to freeze your whole pipeline.
Why it trips people up
The risk isn’t the rule itself; it’s losing track of it across high claim volume. File a fresh dispute on a service that’s still inside a prior determination’s 90-day window and it can be dismissed — after you’ve already paid the non-refundable administrative fee.
Claims aren’t lost — they’re deferred
Items and services that would have been initiated during the 90 days don’t disappear. They can be brought once the period closes, and are generally batched together at that point. The window pauses re-filing; it doesn’t extinguish the claim.
How Equavis helps
Equavis tracks every determination against its 90-day window by plan and service, so claims that fall inside a cooling-off period are queued and filed the moment it lifts — not submitted early and dismissed.
Frequently asked questions
What is the IDR cooling-off period?
After a certified IDR entity issues a determination, the No Surprises Act bars the initiating party from starting a new IDR dispute against the same other party for the same or similar item or service for 90 calendar days. It's one of the eight federal IDR eligibility criteria, so a dispute that runs afoul of it can be dismissed.
Does the cooling-off period block all new disputes for 90 days?
No. It applies to the same parties and the same or similar item or service. Claims for different services, or against a different plan, are not blocked. The point is to prevent immediately re-litigating the same matter, not to freeze your entire dispute pipeline.
What happens to claims that come up during the 90 days?
They aren't lost. Items and services that would otherwise have been initiated during the cooling-off period can be brought once the period ends, and are generally batched together at that point. The window pauses re-filing on the same matter; it doesn't extinguish the underlying claims.