Successfully Managing the Federal IDR Process for Surprise Medical Billing (W6048)-Successfully Managing the Federal IDR Process for Surprise Medical Billing Recording

Successfully Managing the Federal IDR Process for Surprise Medical Billing Recording

Video Transcription

Video Summary

Kimo Gandahl, founder and CEO of Arbitris, reviewed the federal and Georgia independent dispute resolution (IDR) processes for out-of-network medical claims. He explained how to determine jurisdiction and eligibility, meet filing deadlines, and distinguish plan types. Federal cases generally allow 30 business days for open negotiation, followed by a strict four-business-day window to initiate IDR; Georgia allows a longer filing period. The systems also differ in benchmarks, batching limits, and payment timelines.<br /><br />Gandahl covered common dismissal arguments, the importance of responding promptly with supporting documentation, and how to seek reopening when a case is dismissed in error. He emphasized that winning an arbitration may not ensure payment: providers should track deadlines and pursue available enforcement procedures. He also discussed the economics of batching claims and using a strong record of arbitration outcomes to support settlements.<br /><br />During Q&A, speakers addressed payer nonpayment, claim-value thresholds, negotiation strategies, and identifying overlooked out-of-network claims—particularly at trauma facilities, near state borders, and along interstate routes. The presentation concluded with resources for follow-up and access to the recording and slides.

Keywords

independent dispute resolution

out-of-network medical claims

federal IDR

Georgia IDR

arbitration deadlines

medical claim negotiation

provider reimbursement