When the insurer doesn’t pay the award

After the certified IDR entity picks an offer, the losing party must pay the amount, less any initial payment, within 30 calendar days of the decision. This is in the federal rules. If the decision came on a Monday, payment is due four weeks and two days later, weekends included.

Keep three dates on every won dispute: decision date, due date (decision plus 30), and the date cash actually posts. If the due date passes with no payment, it’s time to file.

One complaint to the federal No Surprises Help Desk gets routed to the right agency. For fully insured plans, file with the state too, so two agencies are looking at the same insurer.

This covers every plan type and is the one filing you always make.

1. Gather: the IDR decision notice (with dispute ID), the entity’s name, the insurer or plan name and address, the claim and patient details, the amount due, proof of the due date, and any insurer correspondence. Don’t include more patient data than the form asks for.
2. File online: the provider complaint form at nsa-idr.cms.gov/providercomplaints. You get a confirmation number by email. Save it.
3. Or call: 1-800-985-3059, 8am to 8pm ET, seven days a week. The Help Desk will take the complaint by phone and tell you what documents to send.
4. Questions about the process: FederalIDRQuestions@cms.hhs.gov.
5. Follow up: call the Help Desk with your confirmation number if nothing moves in 30 days. Add documents to the existing complaint rather than filing a new one.

Only if the plan is regulated by the state. If the card says self-funded, ERISA or ASO, skip this step; the state has no jurisdiction.

• Providers file through the DFS Portal. First-time users create a Portal account, then request access to the Healthcare Provider Complaint application.
• Cite the late award payment and New York’s prompt pay law. Attach the IDR decision and the due-date math.
• Phone: (800) 342-3736.
• Note: the New York state IDR process changed on August 26, 2026. This page is about federal awards. State IDR awards have their own timelines.

• TDI regulates HMOs and fully insured plans only, which it says is less than a quarter of health coverage sold in Texas. The card should show “TDI” or “DOI.”
• File through the TDI provider complaint portal. TDI closes complaints that are missing the required claim information, so include everything: claim number, dates, amounts, EOB, the IDR decision and the insurer’s response if any.
• Email for questions: ConsumerProtection@tdi.texas.gov.

• Providers can file a complaint about a New Jersey-regulated carrier through DOBI’s consumer complaint process, and prompt-pay disputes have their own Provider Prompt Pay Review (both atDOBI’s prompt payment page).
• New Jersey has its own prompt payment law and its own state arbitration. If the award came from the New Jersey process, not federal IDR, use DOBI’s process for that.

• Providers email the Bureau’s Balance Billing Complaint Form to bureauofinsurance@scc.virginia.gov, or file by mail to Bureau of Insurance, P.O. Box 1157, Richmond, VA 23218. The form is on the Bureau’s balance billing page.
• Toll free: 1-877-310-6560.
• The Bureau only acts on plans it regulates. Self-funded plans go to DOL, unless the plan opted in to Virginia’s law.

Any other state: every state insurance department takes provider complaints. Start at the department’s website and look for “provider complaint.” Ask us if you’re not sure which office.

ERISA plans are enforced by the U.S. Department of Labor. Your Help Desk complaint gets referred there. You can also contact EBSA directly at 1-866-444-3272 or through askebsa.dol.gov. To confirm EBSA’s current intake path for provider award complaints. In practice the federal Help Desk filing is the one that moves; file it first.

• CMS’s complaint report counts 664 complaints about late payment after an IDR determination from 2022 through 2025. Closed investigations across all complaint types have produced about $30 million in direct monetary relief. That’s real money, but it’s slow and it’s a fraction of unpaid awards.
• The 2026 federal IDR rule didn’t add penalties for non-payment. The NSA Enforcement Act (S. 2420 / H.R. 4710) would add penalties and interest. Not law yet.
• Some providers are testing lawsuits in other circuits. No ruling yet that opens the courthouse door.
• A complaint is also a record. If a payer builds a pattern of late payment, that pattern feeds regulator action and petitions. File every one.

The 30-day rule covers award payments. The same discipline applies earlier: open negotiation must start within 30 business days of the initial payment or denial, and IDR must be filed within 4 business days after open negotiation ends. Miss those and there’s no award to collect. See our eligibility and batching pages.

We track the decision date and the 30-day due date on every won dispute, and we draft the complaint on day 31. Your group approves before anything is filed, and we coordinate with your billing team so the payment posting and the complaint match.