April 18, 2022
CMS Opens On-Line IDR Portal for Claims Under the No Surprises Act
On Friday, April 15, 2022, the Centers for Medicare & Medicaid Services (CMS) opened the Federal Independent Dispute Resolution (IDR) portal which allows providers to initiate the IDR process under the No Surprises Act to resolve payment disputes with insurers for certain out-of-network charges.
Stakeholders will have a 30-business day period for open negotiations to come to a good-faith agreement. After the 30-business day open negotiations period, the initiating parties have 4 business days to initiate a dispute via the portal.
Due to the recent ruling in Texas Medical Association, et al. v HHS, disputing parties whose open negotiation expired before April 15, 2022 will have 15 business days (until May 6) to file an initiation notice via the IDR portal. Standard timelines will apply for claims currently in the open negotiations period. Disputing parties can continue to negotiate even after starting the IDR process until the IDR entity makes a determination. Disputing parties with extenuating circumstances can request an extension by contacting the departments via email at [email protected].
ASA members are also encouraged to share their experiences in using the portal. Notifying ASA of issues related to ease of use and functionality will be helpful as ASA continues to work with Congress and the regulating entities to ensure that the IDR process works properly and facilitates users receiving appropriate payments from insurers. Information should be sent to [email protected]