Batching lets an initiating party bring more than one qualified IDR item or service into a single Federal IDR dispute instead of filing one dispute per item. The June 4, 2026 Federal IDR Operations final rule (91 FR 33949) rewrote the batching test that applies once its batching provisions become applicable (45 CFR 149.510(c)(4)). This page describes that test in plain language. It does not tell anyone whether a particular batch will be accepted; that determination is made case by case by the certified IDR entity handling the dispute.
The final rule imposes a limit of 50 qualified IDR items and services as part of a single batched dispute (91 FR 33949 at 34006; 45 CFR 149.510(c)(4)). Before this rule the Departments had proposed a lower cap and raised it to 50 after comment (91 FR 33949 at 34012, discussing the change from a proposed limit of 25). The 50-item figure is a ceiling on how many items one payment determination can jointly resolve, not a minimum -- a batch of any size at or under 50 that otherwise qualifies may proceed. An item beyond the cap is excluded from that batch; it is not automatically denied review outright, and the remainder of the batch, up to the cap, proceeds to determination (45 CFR 149.510(c)(4)).
Separately from the item-count cap, the qualified IDR items and services in a batch must either have been furnished within the same 30-business-day period, or have open negotiation periods ending within the 90-calendar-day suspension period the rule calls the "cooling off" period (45 CFR 149.510(c)(4)(vii)(B); 91 FR 33949 at 34005). An item whose date of service falls outside that 30-business-day window relative to the rest of the batch does not share the timing basis for the batch and can be excluded on that ground alone, independent of whether it also satisfies one of the three permitted bases described below.
Beyond timing and the item cap, the final rule requires that items in a batch relate to each other on one of three bases (91 FR 33949 at 34005-34006; 45 CFR 149.510(c)(4)(i)):
An item that does not share one of these three bases with any other surviving item in the batch does not belong in that batch. It is excluded from the batch rather than causing the entire batch to fail; the remaining items, if they satisfy the timing, cap, and basis requirements among themselves, still proceed to a determination.
For the first basis, it is the initiator who identifies which items it contends were furnished during the same patient encounter on consecutive dates of service. The rule does not require the non-initiating party to independently prove the encounter was different in order for the initiator's assertion to be evaluated -- but any party may raise an eligibility objection to that assertion during the Federal IDR process eligibility review, and the certified IDR entity resolving the dispute decides eligibility, including batching eligibility, as part of that review.
An item that fails the cap, the timing window, or the three-basis test is excluded from the batch. Exclusion from a batch is a determination about how that item may be grouped with others -- it does not by itself decide the substantive determination for the excluded item, and the batch, or the excluded item as its own dispute, may still proceed subject to the Federal IDR process's other eligibility requirements (45 CFR 149.510(c)(2)).
Once a dispute (batched or single) is initiated, the certified IDR entity determines eligibility, including whether the batching requirements above are satisfied.
This guide does not state how long that determination window is. No business-day figure for it appears in the primary rule text reviewed for this page, so naming one here would be an assertion this page cannot support. Two neighbouring clocks that the rule text does state, for orientation: offers and entity fees are due not later than 10 business days after items are determined eligible, and the payment determination follows not later than 30 business days after that same point. Confirm the eligibility window itself against current CMS guidance.
Where required information is missing from a Notice of IDR Initiation, the filing party has an opportunity to cure that defect before eligibility is finally denied on that ground; this guide does not state a specific cure-period length beyond what is confirmed in the primary text, and any such figure should be confirmed against current CMS guidance rather than this page.
Trilatic is preparing an application to become a certified Federal IDR entity and is not accepting disputes. This guide states no outcome and gives no advice on offers or amounts.
Check a batch before filing: /prescreen
A 90-minute recorded session on these rules is available to firms and review organisations; enquiries to research@trilatic.com.