CHA News

Changes Proposed for Independent Dispute Resolution Process

What’s happening: A proposed rule from the departments of Health and Human Services, Labor, and Treasury aims to improve the No Surprises Act (NSA) independent dispute resolution (IDR) process.  

What else to know: Comments on the proposal, which is in response to court rulings that held key provisions of the interim final rules establishing the IDR process impermissible under the NSA, are due Jan. 2.  

Many of the proposals are designed to streamline determinations of whether a claim is eligible for the federal IDR process. Among other changes, if finalized, the rule would: 

  • Require plans to use remittance advice remark and claims adjustment reason codes to indicate to an out-of-network provider whether an item or service is eligible for the federal IDR process.  
  • Modify requirements so that items or services could be batched if they are furnished to a single patient and billed on the same claims form, billed under the same service code (or a comparable one in a different system), or belong to the same Category I CPT code for certain specialties. The rule also limits batched items to 25 line items in a single dispute.  
  • Add requirements to the open negotiation process that require a response from the non-initiating party and create a document trail to verify this step in the IDR process was attempted.  

CHA is currently reviewing the rule and will make a detailed summary and webinar available to its members shortly.