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Checklist
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Your Profile
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Results
IDR Readiness Tool
IDR Operational Readiness Checklist
Tell us a bit about yourself so we can personalize your IDR readiness report and follow up with relevant resources.
IDR Readiness Tool — Step 2 of 3
IDR Operational Readiness Checklist
Check every item your plan currently has in place. Be honest — accuracy gives you a more useful score.
0 of 25 items checked
1
Case Management & System of Record
0 / 5
All IDR disputes are logged in a single, centralized system of record
Not spreadsheets, shared drives, or claim system notes — a purpose-built or designated
case management platform
Each IDR case record includes full case history from open negotiation through
determination
All correspondence, offers, IDRE selection, documentation, and final outcome in one
record
Cases involving delegated or capitated providers are flagged and routed to appropriate
ownership
Delegation blind spots are a leading cause of unmanaged IDR exposure
Batch-eligible disputes are identified systematically and managed as a unit
Batch submissions reduce administrative cost but require structured identification and
tracking
The case management system produces a complete, auditable record exportable for CMS
audit purposes
If CMS requested your IDR case history tomorrow, you could produce it cleanly within 24
hours
2
Deadline Tracking & Timeline Compliance
0 / 5
The 30-business-day open negotiation window is tracked automatically for every
eligible dispute
Automated, not calendar-based or analyst-dependent
The 4-business-day IDR initiation window is tracked with automated alerts and
escalation
Missing this window forfeits IDR rights on that claim — there is no grace period
The 10-business-day IDRE selection window is tracked and actioned before the CMS
assignment default
CMS-assigned IDREs may not favor the plan’s preferred dispute resolution approach
Deadline alerts have a defined escalation path if the responsible party does not act
An alert that nobody acts on is not a deadline tracking system
Your plan has had zero missed IDR deadlines in the past 12 months
Or, if deadlines were missed, root cause was analyzed and controls were updated
3
QPA Accuracy & Defensibility
0 / 5
QPA calculation methodology is documented in a written, version-controlled policy
Includes service code mapping approach, geographic region definition, affiliated
contract inclusion criteria, and median calculation method
QPA is calculated from versioned rate data — not recalculated from current rates at
time of dispute
The QPA must reflect rates in effect at the time of service, not current contracted
rates
QPA methodology has been reviewed by qualified legal or actuarial counsel in the past
12 months
Post-TMA litigation, QPA weighting rules have changed — counsel review ensures your
methodology reflects current requirements
Each IDR submission includes a complete QPA documentation package — not just the
number
Methodology, data sources, version references, and calculation outputs presented as a
coherent documentation record
QPA records are retained per your document retention policy and accessible by dispute
case ID
You can retrieve the QPA documentation for any dispute in the past 3 years within one
business day
4
Delegation & Operational Accountability
0 / 5
IDR disputes originating from delegated or capitated arrangements have a defined
ownership and workflow
It is clear who is responsible for open negotiation, IDR initiation, and submission for
delegation-related disputes
Delegation agreements include IDR accountability provisions — escalation paths and
notification requirements
Your delegates know their obligations when a dispute arises from services they manage
Your plan has visibility into IDR disputes filed against delegated entities on your
behalf
You are not learning about delegate IDR exposure after the fact
A designated IDR program owner exists with cross-functional authority over compliance,
claims, and legal
IDR managed by committee without a single owner produces accountability gaps
NSA-related Corrective Action Plans, if any, are tracked through resolution with
documented evidence
CMS findings require structured remediation — not informal course correction
5
Reporting, Visibility & Regulatory Currency
0 / 5
Leadership receives regular IDR reporting — volume, financial exposure, win/loss
trend, and operational metrics
At minimum quarterly; monthly for plans with high IDR volume
Your plan has real-time or near-real-time visibility into aggregate IDR financial
exposure
Potential payment obligations if outstanding cases resolve unfavorably are tracked and
reported
Your compliance calendar includes all CMS NSA/IDR reporting deadlines and regulatory
update monitoring
NSA guidance and court decisions affecting IDR rules are tracked and actioned through a
defined process
IDR outcome data is analyzed to identify QPA methodology issues, provider patterns, or
service category exposure
Losing consistently on certain service types or with certain providers is a signal, not
just a cost
Your IDR program has been reviewed against current CMS guidance and post-TMA
litigation requirements in the past 12 months
The regulatory environment has changed materially since 2022 — an annual review is the
minimum standard
IDR Operational Readiness Report
0
/ 25
⚠ Exposed (0–10)
Significant operational and regulatory risk. Priority: build case management foundation and deadline tracking immediately.
⚡ Developing (11–19)
Core elements exist but gaps remain. Priority: QPA defensibility, delegation accountability, and leadership reporting.
✓ Ready (20–25)
Strong operational foundation. Priority: maintain currency with regulatory changes and optimize for efficiency at scale.
Domain Scores
Your performance across the five IDR readiness
domains
See What IDR-Ready Looks Like on Your Platform
Inovaare’s compliance operations platform connects case management, deadline tracking, QPA data infrastructure, delegation oversight, and enterprise reporting in a single system built for health plans. Book a 30-minute IDR Readiness Assessment to see how your plan’s gaps map to Inovaare’s capabilities.