Eliott Dear on the State IDR Timeline: What to Expect After Filing

The First Question

Physicians who file state IDR submissions through Claims Assassins ask the same question on every intake call: how long does this take? The timeline varies with the insurer, the payer contract structure, and whether the insurer requests a hearing extension.

Eliott Dear has been filing state IDR submissions in New York for long enough that the timeline curve is stable. A typical case resolves within about 90 days of filing. Some resolve within 60 days. The slow ones extend past 120 days, usually because the insurer invoked an administrative delay provision that the state IDR entity had to rule on separately.

What Happens In Each Stage

Stage one, days 0 to 14. The submission is filed with the state IDR entity. The entity assigns a case number, sends a notice to the insurer, and opens a 14-day response window for the insurer to file a counter-brief or accept the provider’s requested amount. Most insurers file a counter-brief.

Stage two, days 15 to 45. The case moves to an assigned arbitrator or IDR entity panel. The arbitrator reviews the FAIR Health benchmark data, the CPT coding, the plan classification, and the insurer’s counter-argument. In New York, the typical assignment-to-determination window is 30 days, though this varies by volume.

Stage three, days 46 to 75. The arbitrator issues a determination. A determination carries a 30-day payment deadline, and DFS administers New York’s IDR.

Stage four, days 76 to 120, if needed. When the 30-day payment deadline passes without payment, Claims Assassins sends the payment demand and files a complaint with the DFS Consumer Assistance Unit.

How the Timeline Compares

A 90-day timeline on a state IDR case is faster than a 9-month negotiation on the same claim through direct insurer-contract appeals. And New York state IDR measures the claim against the FAIR Health 80th percentile, the benchmark named in New York law, not against the insurer’s initial payment.

What Affects the Timeline

The biggest single factor that extends the timeline is missing or incomplete documentation at the filing stage. A filing that lacks the facility-level ZIP code for FAIR Health lookup, or that lacks the operative report for complex CPT codes, will generate arbitrator questions that delay the determination. Eliott Dear’s intake review catches these gaps before filing.

Claims Assassins files in the morning, answers arbitrator questions within 24 hours, and tracks the 30-day payment deadline on every determination.