Permitted and prohibited factors in IDR (45 CFR 149.510)
The regulation is explicit about what belongs in your evidence and what must stay out. Building to it is the whole discipline.
As of 2026-08-03 · 6 min read · Keyword: IDR permitted factors
Permitted additional information
Under 45 CFR 149.510, a certified IDR entity considers the qualifying payment amount and may weigh additional permitted information such as the provider's training and experience, the acuity of the patient or complexity of the service, the market share of the parties, prior contracted rates, and good-faith efforts to reach a network agreement.
Prohibited factors
- Billed charges and the provider's usual-and-customary rate.
- Public-payer rates: Medicare, Medicaid, CHIP, and TRICARE.
- Any factor the regulation excludes from consideration.
Keep the QPA out of your assembly
You assemble permitted-factor evidence; you do not calculate the QPA. Logic Refinery IDR-A is built to that boundary, Medicare-based benchmarking, for example, belongs only in open negotiation, never in an IDR submission.
Building the evidence package
- 1Map each piece of evidence to a permitted factor.
- 2Exclude prohibited factors at intake, not at review.
- 3Attach a source and a hash to every document.
- 4Record the named reviewer who signed off.
Sources & evidence tiers
- Verified45 CFR 149.510 (permitted and prohibited factors)
Figures are cited as of 2026-08-03 and reflect data available at that time. The IDR data environment moves quickly; verify current rules and figures with CMS and counsel.