Compliance Corner

Federal Updates

Departments Issue FAQs on Federal Independent Dispute Resolution Process

February 15, 2022

As background, the No Surprises Act (the Act) prohibits out-of-network healthcare providers from imposing balance bills for emergency services and air ambulance services. Similarly, out-of-network healthcare providers working at in-network facilities may not impose balance bills for certain nonemergency services, including anesthesiology and radiology services. As an integral part of the Act, the regulations established the Federal Independent Resolution (IDR) process for out-of-network providers, plans and insurers to resolve payment disputes if the parties cannot agree on the payment amount after they attempt to hold an open negotiation. The Federal IDR process was effective January 1, 2022.

The Treasury, DOL and HHS (the departments) have released guidance on this process in the form of 47 frequently asked questions and answers. Highlights include:

  • Several model notices and forms have been provided for use in the IDR process, such as Notice of Selection of IDR Entity, Notice of Offer and Notice of Agreement on an Out-of-Network Rate.
  • The party initiating the IDR process will propose a certified IDR entity from the list available in the Federal IDR portal. If the other party does not approve, they must agree on another. If an agreement cannot be reached, the departments will select one at random. (Note: The portal is not yet available.)
  • For 2022, each involved party must pay a $50 administrative fee for the IDR process.
  • Generally, IDR entities must make a payment decision within 30 days of being selected.
  • Some states have adopted their own IDR process, while others will default to the federal process. Those decisions are identified here.
  • The departments expect 17,000 IDR’s annually.

Carriers or third-party administrators generally handle the IDR process in payment disputes between group health plans and providers. However, it is recommended that employers familiarize themselves with the general process.

Frequently Asked Questions Regarding the Federal Independent Dispute Resolution Process »