On Dec. 27, 2020, the No Surprises Act (NSA) was signed into law to address unexpected gaps in insurance coverage that result in “surprise medical bills” when patients unknowingly obtain medical services from physicians and other providers outside their health insurance network.  The NSA and its implementing regulations establish a Federal Independent Dispute Resolution (IDR) process that out-of-network (OON) providers may use to determine the OON rate for qualified IDR items or services after an unsuccessful open negotiation period to resolve pending claims.

Do you have pending disputes resulting from IDR process for resolving claims that were bundled or batched? On May 1, the Departments of Health and Human Services, Labor, and the Treasury announced a new process for resubmitting those IDR disputes that were originally improperly batched or bundled. The resubmission process is automated in the Federal IDR portal and is intended to streamline the process.

CMS has provide the following overview of the process, including links and associated deadlines.

OVERVIEW OF THE NEW PROCESS

Parties now have a new way to resubmit disputes that were originally improperly batched or bundled. Resubmission requests will come directly from the Federal IDR portal instead of from your certified IDR entity, and initiating parties now will have a unique web form they can access via a link in their resubmission email notification to complete the resubmission process.

If you are a party to a dispute that is eligible to be resubmitted to the Federal IDR process, you will receive an email notification from [email protected]. If you initiated the dispute, the resubmission email notification will contain a unique link to a new form called the Notice of IDR Initiation – Resubmission web form and instructions on the next steps. If you did not initiate the original dispute, your email notification will be informational and will not have a link.

Initiating parties have 4 business days from the date of the resubmission email notification to resubmit a dispute. The resubmission link will no longer work after the 4 business day window has passed.

RESUBMISSION REQUESTS RECEIVED ON OR BEFORE APRIL 30, 2024

If a certified IDR entity notified you on or before April 30, 2024, that a dispute you submitted was eligible for resubmission due to improper batching or bundling, please resubmit the dispute as instructed in the email from your certified IDR entity through the Notice of IDR Initiation web form. For information on how to resubmit these disputes, refer to the Notice of Initiation Web Form Job Aid.

The Notice of IDR Initiation web form will accept resubmitted disputes through May 6, 2024. After May 6, 2024, the Notice of IDR Initiation web form will no longer accept resubmitted disputes, and all resubmissions must be submitted via the Notice of IDR Initiation – Resubmission web form as described in the paragraph below.

RESUBMISSION REQUESTS RECEIVED ON OR AFTER MAY 1, 2024

Starting on May 1, 2024, certified IDR entities will notify parties through an email from the Federal IDR portal that a dispute is eligible for resubmission due to improper batching or bundling. Initiating parties will receive a resubmission email notification that will direct them to a unique web form called the Notice of IDR Initiation – Resubmission web form to complete the resubmission process.

EDUCATIONAL MATERIALS

For additional information and instructions on how to complete and submit the new Notice of IDR Initiation – Resubmission web form, refer to the following resources linked below:

QUESTIONS?

Questions can be directed to the Federal IDR Questions mailbox at [email protected].