Before a certified IDR entity ever weighs an offer, it must decide whether the dispute is eligible for the Federal Independent Dispute Resolution (IDR) process at all (45 CFR 149.510(c)(2)). This page lists the grounds a certified IDR entity checks, each tied to its own paragraph of 45 CFR 149.510, and states which reasons the Departments themselves have identified as the most common causes of ineligibility. It does not say whether any specific dispute meets or fails any ground; that determination is made case by case by the certified IDR entity handling the dispute (45 CFR 149.510(c)(2)(i)).
1. The payer or coverage type is one the No Surprises Act reaches. The item or service must be furnished under coverage subject to the No Surprises Act's protections; it fails this ground if payable under Medicare, Medicaid, or a plan whose out-of-network rate is instead set by a specified State law or an All-Payer Model Agreement under section 1115A of the Social Security Act (45 CFR 149.510(a)(2)(xi)(A)). The Departments identify this as one of the two most common reasons disputes are found ineligible, describing "an item or service that is not a qualified IDR item or service because it is payable by a health plan or coverage that is not subject to the surprise billing protections of the No Surprises Act, such as Medicare or Medicaid, or because the item or service is subject to a specified State law or an All-Payer Model Agreement" (91 FR 33949 at 100).
2. The service category conditions are met. The item must be an emergency service, a non-emergency service furnished by a nonparticipating provider at a participating facility, or an air ambulance service, each subject to its own regulatory conditions under 45 CFR 149.110, 149.120, or 149.130 (45 CFR 149.510(a)(2)(xi)(A)).
3. A notification was actually submitted. The item must be one for which a party submitted the notification required under paragraph (b)(2) -- the notice of IDR initiation (45 CFR 149.510(a)(2)(xi)(B)).
4. The item is not still in open negotiation. An item currently the subject of an unresolved open negotiation under paragraph (b)(1) is not yet a qualified IDR item or service (45 CFR 149.510(a)(2)(xi)(C)).
5. The item is not caught by the re-filing bar following a prior determination. An item for which a notification was submitted during the 90-calendar-day period described in paragraph (c)(4)(vi)(B) is excluded, unless the notification was instead submitted during the subsequent 30-business-day period in paragraph (c)(4)(vi)(C) (45 CFR 149.510(a)(2)(xi)(D)).
6. Open negotiation actually ran its course. The parties must have completed the 30-business-day open negotiation period before either can initiate the Federal IDR process (45 CFR 149.510(b)(1)(i)).
7. Initiation happened inside the 4-business-day window. A party must submit the notice of IDR initiation during the 4-business-day period beginning the first business day after open negotiation ends (45 CFR 149.510(b)(2)(i)); see our companion guide on that window for a worked, holiday-aware example.
8. The correct non-initiating party was named. The dispute is filed against the actual counterparty to the claim. The Departments cite disputes "initiated against the wrong non-initiating party" as a contributor to the ineligible-dispute volume they project (91 FR 33949 at 2056).
9. Any batching in the dispute follows the batching test. If the dispute batches more than one item, each item must meet the cap, timing window, and one of the three permitted bases under paragraph (c)(4)(i); an item that does not is excluded from the batch rather than voiding the whole dispute, but it does not itself proceed (45 CFR 149.510(c)(4)(i); see our batching worked examples).
Beyond the payer/coverage-type ground above, the Departments' preamble names incorrect batching as the other leading cause: "many batched disputes were found ineligible due to the initiating party incorrectly batching items or services in a manner that did not comply with the regulations, such as batching claims paid by different plans or issuers" (91 FR 33949 at 100). The Departments separately estimate that, absent other changes in this rule, approximately 585,000 disputes could be found ineligible annually under current volume projections, and project that enhanced disclosure and portal-based negotiation requirements in this rule could cut that figure by 50 to 75 percent -- 292,500 to 438,750 disputes a year (91 FR 33949 at 2056).
A certified IDR entity must make its eligibility determination and notify both parties no later than 5 business days after its final selection (45 CFR 149.510(c)(2)(i)). If it finds the item or service is not a qualified IDR item or service eligible for the Federal IDR process, "the dispute will be closed, and the selected certified IDR entity will not take any further action with respect to the dispute" (45 CFR 149.510(c)(2)(i)) -- no offers are exchanged and no payment determination is made. In a batched dispute, this happens item by item: only the items found both qualified and compliant with the batching test in paragraph (c)(4)(i) continue (45 CFR 149.510(c)(2)(i)).
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. It is not legal advice. Published 2026-09-13; last checked against primary sources on 2026-09-13.
A free, stateless eligibility pre-screen is available at /prescreen. Check your dispute before you pay the fees: /precheck