Eliott Dear on the State IDR Timeline: What to Expect Between Filing and Payment

The Honest Answer

Physicians who file state IDR submissions through Claims Assassins ask the same question on every intake call. How long until the money shows up. The honest answer is 60 to 120 days in New York from filing to payment on an insured claim, with variance based on insurer, 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. The average case resolves within 90 days of filing. The fastest 20 percent resolve within 60 days. The slowest 20 percent 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. If favorable to the provider, the insurer has 30 days to pay the determined amount. Most insurers pay within the 30-day window because DFS enforcement authority is real and immediate.

Stage four, days 76 to 120 (if applicable). Delayed payment cases. If the insurer does not pay within 30 days of the determination, Claims Assassins files a complaint with the DFS Consumer Assistance Unit, which triggers direct insurer contact from a regulator. The vast majority of delayed payments resolve within an additional 30 days of DFS contact.

Why the Timeline Is Worth It

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. It is much faster than federal IDR, where the front-end timeline is similar but the collection timeline extends indefinitely due to the enforcement gap. And it is far faster than the collection-agency route, which typically takes 6 to 18 months and yields a fraction of the billed amount.

The FAIR Health 80th percentile benchmark used in New York state IDR typically produces a recovery 3 to 5 times the insurer’s initial payment. A 90-day wait for that level of recovery is the fastest state IDR has ever been and the highest-yield recovery path available to non-par providers in the six Claims Assassins jurisdictions.

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, which is why Claims Assassins submissions typically close on the 60-90 day side of the curve rather than the 90-120 day side.

Claims Assassins files in the morning, answers arbitrator questions within 24 hours, and monitors DFS enforcement at the 30-day payment mark. The pipeline runs on the 60 to 120 day window, and physicians can plan around that window with confidence.