The Centers for Medicare & Medicaid Services (CMS) has released additional resources that can help facilities and providers prepare for the independent dispute resolution (IDR) process included in the No Surprises Act (NSA), which took effect on Jan. 1.
The resources include additional guidance on the IDR process, related FAQs, and a list of IDR entities. CHA encourages members to share them with the teams within their organization that are responsible for implementing the processes necessary to comply with the NSA.
- Federal IDR Process Guidance for Certified IDR Entities: CMS has released additional guidance on the IDR process. While the guidance is intended for the IDR entities, it offers providers a useful overview of the steps and timelines necessary to complete the federal IDR process. It clarifies that providers must use the Department of Labor’s model “open negotiation notice” to satisfy the open negotiation requirement necessary to access the IDR process. The guidance also describes the data elements required to complete the “notice of IDR initiation” if the open negotiation does not result in an adequate payment offer from the health plan for services covered under the Act. The document includes a timeline for the IDR process beginning on page 6 and lists the documents providers are required to use during each step of the process on page 36.
- FAQs Related to IDR and Notice and Consent: CMS has provided FAQs on the IDR and notice and consent process. The FAQs indicate that CMS will offer technical training for providers on using the IDR system in the coming weeks. In the meantime, the agency encourages providers to call the NSA Help Desk at (800) 985-3059 between 5 a.m. and 5 p.m. (PT), seven days a week, with questions.
- List of IDR Entities: The tri-agencies have certified eight organizations (as of Jan. 4) to serve as IDR entities in the federal dispute resolution process between health plans and providers. The application process for IDR entities remains open, and the list will be updated on a rolling basis.
CHA’s resources to help members understand and comply with the NSA’s requirements are available online.