About this form

Use this form to pay your IDR invoice.

Only Independent Dispute Resolution (IDR) and Selected Dispute Resolution (SDR) entities should make payments through this form. IDR and SDR entities will need their invoice number and payee ID information to continue with this form. Disputing parties, including uninsured (or self-pay) individuals, plans, issuers, providers, facilities, and providers of air-ambulance services, should not utilize this form. Disputing parties should make all fee payments to their IDR or SDR entity. More information for disputing parties is available at https://www.cms.gov/nosurprises.

Accepted Payment Methods:

• Bank account (ACH)

With an account you can:

• See the payments you made since you created an account.
• Store payment information so you don't have to re-enter it.
• Copy a form you already submitted the next time you need to make a payment.

To take advantage of these benefits, you can Sign In . If you don't have an existing account, you will have the option to create an account on the sign-in page. To continue as a guest user, click the 'Continue to the Form' button.