Notices

The Departments of Health and Human Services, Labor, and the Treasury (the Departments) will post important information regarding the No Surprises Act to this page. Please check back frequently for updates.

July 19, 2024

On 7/19/2024, the Departments announced that they will grant disputing parties impacted by the CrowdStrike Windows outage a one business day extension for any activity in the federal Independent Dispute Resolution (IDR) process that has a due date on 7/19/2024. Below is a list of the specific extensions and how they will be implemented.    

Notice of Initiation
Initiating Parties that started open negotiation for a qualified item or service on 5/31/2024 can select the extension reason of “I received an extension approval from the federal IDR mailbox and will upload evidence of this extension in the Supporting Documentation section of this webform” on page 2 of the Notice of Initiation webform and attach a copy of this notice as evidence.

Resubmission - Notice of Initiation
Disputing Parties with a resubmission due date of 7/19/2024 will automatically be granted a one business day extension and can submit their webform by end of day 7/22/2024.

Certified IDR Entity Selection 
Disputing Parties with a selection response due date of 7/19/2024 will automatically be granted a one business day extension and can submit their response by end of day 7/22/2024.

Notice of Offer 
Disputing Parties with a notice of offer due date of 7/19/2024 will automatically be granted a one business day extension and can submit their Notice of Offer webform by end of day 7/22/2024.

Admin and Entity Fees
Disputing Parties with a fee submission due date of 7/19/2024 will be granted a one business day extension and can submit the fees to their selected certified IDR entity by end of day 7/22/2024.

The Departments will continue to monitor impacts from the CrowdStrike Windows outage to determine if any additional actions are necessary.   
 

June 14, 2024

The Departments are aware that Change Healthcare—a unit of UnitedHealth Group—was impacted by a cybersecurity incident in late February. The Departments recognize the impact this attack has had on health care operations across the country, including certain parties’ ability to initiate open negotiation, the initial stage of the Federal independent dispute resolution (IDR) process.

The Departments have received reports from providers, facilities, and providers of air ambulance services that they are unable to initiate open negotiation because they have not received necessary payment information or disclosures from plans or issuers due to disruptions to claims processing resulting from the Change Healthcare cybersecurity incident. In “FAQs About Affordable Care Act And Consolidated Appropriations Act, 2021 Implementation Part 55 (PDF)” (FAQs Pt. 55), the Departments explained that if a plan or issuer fails to timely disclose the information it is required to with each initial payment or sending a notice of denial of payment,* providers, facilities, and providers of air ambulance services may request an extension to initiate the Federal IDR process by emailing a request for extension due to extenuating circumstances to FederalIDRQuestions@cms.hhs.gov. 

However, the Departments recognize that payment for a very large volume of items and services was impacted by the Change Healthcare cybersecurity incident, making individual extension requests burdensome for disputing parties and for the Departments. Additionally, the Departments understand that it may be difficult to determine the date of initial payment or notice of denial of payment for an item or service impacted by the cybersecurity incident, as in some cases, disruptions to payment transmissions have made it difficult to match payments received to specific items or services furnished.

Therefore, the Departments are announcing that providers, facilities, and providers of air ambulance services whose ability to timely initiate open negotiation for any item or service furnished on or after Jan. 1, 2024, was impacted by the Change Healthcare cybersecurity incident may choose to initiate open negotiation for such items or services at any point during the 120-calendar-day period following the publication of this notice, beginning 6/14/2024 and ending 10/12/2024, regardless of when the payment or notice of denial of payment and disclosures were transmitted. Parties may take advantage of this exception period by attesting that their ability to initiate open negotiation timely for an item or service was impacted by the effects of the cybersecurity incident. 

The Departments have published an attestation (PDF) that providers, facilities, and providers of air ambulance services must furnish to plans or issuers alongside the standard open negotiation initiation form, and that providers, facilities, and providers of air ambulance services initiating the federal IDR process must furnish to non-initiating plans or issuers and certified IDR entities alongside the standard IDR initiation form, in order to invoke this exception period. Parties seeking to invoke this exception do not need to request extensions individually via the Federal IDR Inbox, as outlined in FAQs Pt. 55 (PDF). 

IDR entities will be responsible for adjudicating, as part of their eligibility determination, any disagreement as to whether the initiating party is eligible to initiate open negotiation during this 120-day exception period. Non-initiating parties who believe disputes should not be eligible for this exception should provide documentation to support that assertion to initiating parties through open negotiation, as well as to certified IDR entities via the certified IDR entity selection process. See section 5.5 of Federal Independent Dispute Resolution (IDR) Process Guidance for Disputing Parties (PDF). 

The Departments will continue to monitor the progress toward the restoration of normal clearinghouse operations and will timely reevaluate whether it is necessary to provide additional time beyond the 120-calenday-day exception period, providing additional guidance as appropriate.

*See 26 CFR 54.9816-6T(d)(1) or (2), 26 CFR 54.9816-6(d)(1), 29 CFR 2590.716-6(d)(1) or (2), and 45 CFR 149.140(d)(1) or (2).

May 1, 2024

The Departments are announcing the official release of a new process for resubmitting Independent Dispute Resolution (IDR) disputes that were originally improperly batched or bundled. This new resubmission process will streamline Federal IDR operations and enhance the user experience. 

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. 

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:

• Notice of IDR Initiation – Resubmission Web Form User Guide (PDF)
• Notice of IDR Initiation – Resubmission Web Form Recorded Demo
  
  
   

Notices from 2023

December 21, 2023

On December 15, 2023, the Departments of Health and Human Services, Labor, and the Treasury (collectively, the Departments) reopened the Federal IDR portal to process all dispute types, including previously initiated batched disputes, new batched disputes, and new single disputes involving air ambulance services. Beginning at that time, parties can access extensions of the applicable IDR deadlines for the previously initiated batched disputes, as well as for newly initiated batched disputes and newly initiated single disputes involving air ambulance services that the Departments had announced on November 28, 2023. 

Additionally, the Departments received feedback from disputing parties, including providers, providers of air ambulance services, health plans and issuers, that the previously announced extensions do not provide enough time to complete the IDR activities, given the significant backlog of batched and air ambulance disputes that were unable to be submitted during the suspension of those operations in the Federal IDR portal. As such, on December 21, 2023, the Departments announced a further extension of deadlines, giving parties additional time to complete certain IDR activities that were impacted by the temporary suspension of IDR operations due to the rulings in Texas Medical Association, et al. v. U.S. Department of Health and Human Services, et al., Case No. 6:22-cv450-JDK (TMA III) and Texas Medical Association, et al. v. U.S. Department of Health and Human Services, et al., Case No. 6:23-cv-59-JDK (TMA IV), as follows: 

• Extension Dates: Parties for whom the IDR initiation deadline under applicable regulations fell on any date between August 3, 2023, and December 14, 2023, (period of temporary suspension of IDR operations) will have until the 60th business day after December 15 (date of Federal IDR portal reopening), which is March 14, 2024, to initiate a new batched dispute or a new single dispute involving air ambulance services. Parties for whom the regulatory IDR initiation deadline for a batched or air ambulance dispute falls between December 15, 2023, and March 13, 2024, will also have until March 14, 2024, to initiate such disputes. Parties whose initiation deadline falls on March 14, 2024, or after will have the usual 4 business days after the end of the Open Negotiation Period, or if the dispute is subject to the 90-calendar-day suspension period following a payment determination, the usual 30-business-day period, to initiate a batched or air ambulance dispute in the Federal IDR portal. 
• Applicable Administrative and IDR Entity Fees: With respect to the administrative fee for Federal IDR disputes, for disputes initiated between August 3, 2023, and January 21, 2024, the administrative fee amount is $50 per party per dispute.* On December 21, 2023, the Departments published final rules to establish the new administrative fee amount and certified IDR entity fee ranges. The rules are effective starting January 22, 2024. In accordance with 26 CFR 54.9816-8(d)(2)(ii), 29 CFR 2590.716-8(d)(2)(ii), and 45 CFR 149.510(d)(2)(ii), for disputes initiated on or after January 22, 2024, the administrative fee amount is $115 per party per dispute and certified IDR entity fees for disputes initiated on or after January 22, 2024, may be updated to fall within the ranges finalized in December 21, 2023, final rules.**

Also, the Departments are announcing that the following extensions are now available through March 14, 2024, for all dispute types:   

• Disputing parties may request additional time to respond to the certified IDR entity’s requests for additional information. 
• Certified IDR entities may provide parties, upon request, an additional 10 business days after the original offer deadline to submit an offer. 
• Disputing parties involved in any dispute that is initiated through March 14, 2024, will have 10 business days to jointly select a certified IDR entity for those disputes. This extension will be provided automatically and does not require a request by disputing parties.

The Departments are in the process of updating the Federal IDR portal to reflect these extensions. 

*See U.S. Department of Health and Human Services, U.S. Department of Labor, and U.S. Department of the Treasury (August 2023) Federal Independent Dispute Resolution (IDR) Process Administrative Fee FAQs (PDF). 

**See 88 FR 88494, pages 88494-88525.

December 15, 2023

On December 15, 2023, the Departments reopened the Federal IDR portal to process all dispute types, including previously initiated batched disputes, new batched disputes, and new single disputes involving air ambulance services. 

The Departments are granting extensions of the applicable IDR deadlines for the initiation of new batched disputes and new single disputes involving air ambulance services, resubmission of disputes determined by certified IDR entities to be improperly batched, and selection or reselection of a certified IDR entity.

• Parties for whom the IDR initiation deadline under applicable regulations fell on any date between August 3, 2023, and December 15, 2023, will have until the 20th business day after the Federal IDR portal reopens, which is January 16, 2024, to initiate a new batched dispute or a new single dispute involving air ambulance services. Parties for whom the IDR initiation deadline falls between December 16, 2023, and January 15, 2024, will also have until January 16, 2024, to initiate a batched or air ambulance dispute. Parties whose initiation deadline falls on January 16, 2024, or after will have the usual 4 business days after the end of the Open Negotiation Period, or if the dispute is subject to the 90-calendar-day suspension period following a payment determination, the usual 30 business day period, to initiate a batched or air ambulance dispute in the Federal IDR portal. 
• For batched disputes and single disputes involving air ambulance services initiated under extensions of deadlines after the Federal IDR portal reopens, the deadline for the parties to jointly select a certified IDR entity will be 10 business days after initiation. 
• For disputing parties that were engaged in certified IDR entity selection for batched disputes when the Federal IDR portal temporarily closed, the deadline for parties to jointly select a certified IDR entity will be 10 business days after the Federal IDR portal reopens, which is December 29, 2023. 
• An initiating party that has received a notification from a certified IDR entity that a dispute initiated before August 3, 2023, was improperly batched will have one opportunity to resubmit the improperly batched items and services for reconsideration within 10 business days of being notified by the certified IDR entity, provided that the initiating party’s 4-business-day period to resubmit the batched dispute expired between August 3 and August 9, 2023. 
• The deadline to submit fees and offers will remain 10 business days after certified IDR entity selection. 
• Disputing parties with batched disputes that were impacted by the temporary suspension of use of the notice of offer form will be granted an additional 10 business days to submit offers, as communicated to impacted disputing parties by email from the Federal IDR Inbox. 

On November 22, 2023, the Departments used their statutory authority (Internal Revenue Code Section 9816(c)(9), ERISA Section 716(c)(9), and PHS Act Section 2799A-1(c)(9) to grant extensions in the following circumstances:  

• Disputing parties may request additional time, beyond the current business day deadline, to respond to the certified IDR entity’s requests for additional information. The Departments instructed certified IDR entities to grant such requests through January 16, 2024. 
• Certified IDR entities may provide parties, upon request, an additional 10 business days after the original offer deadline to submit an offer. Certified IDR entities may provide parties this additional time, as needed, through January 16, 2024. 

On November 29, 2023, the Departments also announced another extension of the timeline for disputing parties to select a certified IDR entity:  

• Disputing parties will have 10 business days to select a certified IDR entity for all disputes through January 16, 2024. This extension will be provided automatically and does not require a request by disputing parties. 

The Departments already announced the November 22, 2023, and November 29, 2023, extensions until January 16, 2023, for new single and bundled disputes and these extensions will persist for all disputes until January 16, 2023. 

Parties should reference the No Surprises Act (NSA) Independent Dispute Resolution (IDR) Batching and Air Ambulance Policy Frequently Asked Questions (FAQs) (PDF), FAQs about Affordable Care Act and Consolidated Appropriations Act, 2023 Implementation Part 63 (FAQs Part 63) (PDF), FAQs about Consolidated Appropriations Act, 2021 Implementation Part 62 (FAQs Part 62) (PDF), and the August 2023 IDR Administrative Fees FAQs (PDF) for further information. Parties can also reference updated IDR system job aids and updated guidance documents for further information. 

November 1, 2023

The Departments are working to re-open the Federal IDR portal for all batched disputes and single air ambulance disputes. The Departments are aware that disputing parties are actively making decisions about whether to initiate disputes as single disputes for items and services that may subsequently be eligible for submission as a batched dispute once the portal is re-opened for batched disputes. As with prior portal re-opening announcements, the Departments will extend initiation deadlines to allow parties additional time to initiate batched and air ambulance disputes involving items and services for which the IDR initiation period ended during the time that batched and air ambulance dispute initiation was unavailable. 

October 6, 2023

Effective October 6, 2023, the Departments have reopened the Federal IDR portal for the initiation of certain new single and bundled disputes. Processing of in-progress batched disputes, new batched disputes, and new air ambulance disputes remains temporarily suspended while the Departments update batching and air ambulance guidance and operations to align with the district court’s opinions and orders in TMA III and TMA IV. Disputing parties with batched and air ambulance disputes should continue to engage in open negotiation according to the required timeframes. 

The Departments will allow parties impacted by the temporary suspension of the Federal IDR process more time to submit and respond to new disputes.   

• Parties for whom the IDR initiation deadline required by regulation falls on a date beginning on August 3, 2023, through November 3, 2023, will have until the 20th business day after the Federal IDR portal reopens for new dispute processing, which is November 3, 2023, to initiate a new dispute.   
• For new disputes initiated between October 6, 2023, and November 3, 2023, the deadline for certified IDR entity selection will be 10 business days after initiation, and the deadline to submit fees and offers will remain 10 business days after certified IDR entity selection.  
• Disputing parties that were engaged in certified IDR entity selection when the Federal IDR portal temporarily closed will have 10 business days from October 6, 2023, to agree on a certified IDR entity.
• All other deadlines under the Federal IDR process remain unchanged.  

Parties should reference the October 2023 Partial Reopening of Dispute Initiation FAQs (PDF), October 2023 FAQs about Consolidated Appropriations Act, 2021 Implementation Part 62 (FAQs Part 62) (PDF) and the August 2023 IDR Administrative Fees FAQs (PDF) for further information. 

September 21, 2023

Federal IDR Process update: Certain functions of the Federal IDR Process are temporarily paused in response to the TMA IV and TMA III opinions and orders, which were issued on August 3, 2023, and August 24, 2023, respectively. On September 5, 2023, the Departments directed certified IDR entities to resume making eligibility and conflict of interest determinations for all single and bundled disputes submitted on or before August 3, 2023, and encouraged disputing parties to continue engaging in open negotiations. On September 21, the Departments directed certified IDR entities to resume processing all single and bundled disputes submitted on or before August 3, 2023.

The TMA III order vacated certain provisions of the regulation establishing the methodology for calculating the Qualifying Payment Amount (QPA). For disputes initiated prior to the TMA III order, disputing parties have already supplied a QPA, and certified IDR entities should continue to consider the supplied QPA among other factors, and additional information (other than prohibited categories of information) in light of the TMA III order, when selecting between the offers made by the disputing parties to determine which offer best represents the value of the items or services at issue.

The Departments will provide guidance in the near future about other issues associated with these decisions.

September 5, 2023

Effective September 5, 2023, the Departments have directed certified IDR entities to proceed with eligibility determinations for single and bundled disputes submitted on or before August 3, 2023. All other aspects of Federal IDR process operations remain suspended. Disputing parties may continue to engage in open negotiation.  

August 25, 2023

On August 3, 2023, the U.S. District Court for the Eastern District of Texas (district court) issued an opinion and order in Texas Medical Association v. United States Department of Health and Human Services, Case No. 6:23-cv-59-JDK (TMA IV). This opinion and order vacated the batching provisions of 45 C.F.R. § 149.510(c)(3)(i)(C), 26 C.F.R. § 54.9816-8T(c)(3)(i)(C), and 29 C.F.R. § 2590.716-8(c)(3)(i)(C) and vacated the $350 per party administrative fee established by guidance issued on December 23, 2022. Subsequently, on August 24, 2023, the district court issued an opinion and order in Texas Medical Association, et al. v. United States Department of Health and Human Services, Case No. 6:22-cv-450-JDK (TMA III), vacating certain portions of 86 Fed. Reg. 36,872, 45 C.F.R. § 149.130 and 149.140, 26 C.F.R. § 54.9816-6T and 54.9817-1T, 29 C.F.R. § 2590.716-6 and 2590.717-1, and 5 C.F.R. § 890.114(a) as well as certain portions of several guidance documents.

As a result of the TMA III decision, effective August 25, 2023, the Departments have temporarily suspended *all* Federal IDR process operations in order to make changes necessary to comply with the court’s opinion and order. Disputing parties should continue to engage in open negotiation.

Prior to this current suspension, the TMA IV decision, effective August 3, 2023, led the Departments to temporarily suspend all Federal IDR process operations in order to make changes necessary to comply with the court’s opinion and order in that case. On August 8, 2023, certified IDR entities resumed processing batched disputes where the IDR entity determined that the batched dispute was eligible and administrative fees have been paid (or the deadline for collecting fees expired) before August 3, 2023. Processing of other batched disputes and dispute initiation remained temporarily suspended. The subsequent TMA III decision has led to the suspension all of the previously resumed operations.

March 17, 2023

On March 17, 2023, certified IDR entities were instructed to resume making payment determinations for disputes involving items or services furnished on or after October 25, 2022. Certified IDR entities have now resumed processing all payment determinations.

The standards governing a certified IDR entity’s consideration of information when making payment determinations for disputes involving items or services furnished on or after October 25, 2022 are provided in the August 2022 final rules, as revised by the opinion and order of the U.S. District Court for the Eastern District of Texas in Texas Medical Association, et al. v. United States Department of Health and Human Services et al., Case, No. 6:22-cv-372 (February 6, 2023). As of March 17, 2023, the Departments have completed the necessary updates to the Federal IDR portal and Federal IDR process guidance documents to reflect these revised payment determination standards.

Also starting March 17, 2023, disputing parties will begin receiving a majority of their payment determination notices from the IDR portal, specifically from auto-reply-federalidrquestions@cms.hhs.gov. We ask disputing parties to make note of this email address. 

Updated guidance for certified IDR entities to use when issuing payment determinations for items and services furnished on or after October 25, 2022 is posted here (PDF). Updated guidance for disputing parties regarding disputes involving items and services furnished on or after October 25, 2022 is posted here (PDF). (These documents include guidance pertaining to rules that have been vacated by Texas Medical Association, et al. v. United States Department of Health and Human Services, Case No. 6:23-cv-59-JDK or Texas Medical Association, et al. v. United States Department of Health and Human Services, Case No. 6:22-cv-450-JDK. These decisions vacated rules related to batching of IDR disputes, the administrative fee amount for IDR disputes, requirements related to the timeframe for sending an initial payment or notice of denial of payment, the methodology for calculating qualifying payment amounts (QPAs), and/or provisions pertaining to air ambulance disputes. Please review the opinions in the cases cited above for further information on which provisions of the regulations and guidance were vacated and the notes on our website about applicable guidance. Disregard those specific sections of these documents to the extent inconsistent with the court’s opinions.)

February 24, 2023 

On February 24, 2023, certified IDR entities were instructed to resume processing payment determinations on February 27, 2023, for disputes involving items or services furnished before October 25, 2022. The standards governing a certified IDR entity’s consideration of information when making payment determinations in these disputes are provided in the October 2021 interim final rules, as revised by the opinions and orders of the U.S. District Court for the Eastern District of Texas in Texas Medical Association, et al. v. United States Department of Health and Human Services, Case No. 6:21-cv-425 (February 23, 2022) (TMA I), and in LifeNet, Inc. v. United States Department of Health and Human Services, Case No. 6:22-cv-162 (July 26, 2022) (LifeNet I). Disputes involving items or services furnished before October 25, 2022, are not affected by the February 6, 2023 opinion and order in Texas Medical Association, et al. v. United States Department of Health and Human Services et al., Case No. 6:22-cv-372 (February 6, 2023) (TMA II). 

Certified IDR entities will continue to hold issuance of payment determinations that involve items or services furnished on or after October 25, 2022 until the Departments issue further guidance. The Departments are working diligently to complete necessary guidance and system updates in order to allow certified IDR entities to resume processing payment determinations for these disputes. 

All other Federal IDR process timelines continue to apply. Therefore, disputing parties should continue to engage in open negotiations and all other aspects of the Federal IDR process, including submitting fees and offers.

February 10, 2023

On February 6, 2023, the U.S. District Court for the Eastern District of Texas issued a judgment and order in Texas Medical Association, et al. v. United States Department of Health and Human Services, Case No. 6:22-cv-372 (TMA II), vacating certain portions of 45 C.F.R. § 149.510(c), 26 C.F.R. § 54.9816-8(c), and 29 C.F.R. § 2590-716-8(c), which are parallel provisions governing the Federal Independent Dispute Resolution (IDR) process applicable to all payment disputes. The court also vacated the entirety of 45 C.F.R. § 149.520(b)(3), 26 C.F.R. § 54.9817-2(b)(3), and 29 C.F.R. § 2590-717-2(b)(3), which are parallel provisions applicable to air ambulance payment disputes.

As a result of the TMA II decision, the Departments are in the process of evaluating and updating Federal IDR process guidance, systems, and related documents to make them consistent with the TMA II decision. Effective immediately, certified IDR entities should not issue new payment determinations until receiving further guidance from the Departments. Certified IDR entities also should recall any payment determinations issued on or after February 6, 2023. Certified IDR entities should continue working through other parts of the IDR process as they wait for additional direction from the Departments.  

Notices from 2022

November 21, 2022

To support the certified IDREs engaged in making payment determinations under the Federal Independent Dispute Resolution process, the Federal IDR Team is providing technical assistance to certified IDREs on dispute eligibility determinations. Learn more here. (PDF)

November 10, 2022

Due to an unplanned system outage on 11/8/2022 and 11/9/2022, initiating parties may not have been able to submit the Notice of IDR Initiation webform. This system issue was resolved 11/10/2022. The Departments have granted a 4-day extension for initiating parties to access the Notice of IDR Initiation web form to submit IDR payment disputes where the open negotiation period expired on 11/8/2022, 11/9/2022, and 11/10/2022.

October 19, 2022

The Federal IDR portal has a new Notice of Offer webform that disputing parties must use to submit their offers to the IDR entity. Beginning October 19, 2022, all disputes that are not currently within the 10-business day notice of offer phase and that have not already received Notice of Offer forms will receive a web link from the certified IDR entity to submit the Notice of Offer through the Federal IDR portal. View a demo of the new Notice of Offer form.

September 7, 2022

Please be advised that, in order to accommodate the high volume of disputes currently being initiated in the Federal IDR portal, the Departments are allowing certified Independent Dispute Resolution entities additional time to collect information and evaluate the eligibility of disputes. Submitting a complete dispute with all supporting documentation will help to expedite review.

August 16, 2022

The Federal Independent Dispute Resolution (IDR) system is live. During the initial implementation of the program, as parties learn more about the process, some disputes are taking longer than expected to process. In response, the Departments are:

• Granting requests for extensions submitted by the parties or certified IDR entities, as appropriate.
• Monitoring the volume and providing additional guidance to certified IDR entities as necessary.

Please use the following newly published resources to avoid unnecessary delays when initiating disputes:

• Common mistakes and helpful tips for initiating a dispute.
• Technical Assistance for Certified Independent Dispute Resolution Entities-August 2022 Edition (PDF) (This document includes guidance pertaining to rules that have been vacated by Texas Medical Association, et al. v. United States Department of Health and Human Services, Case No. 6:23-cv-59-JDK or Texas Medical Association, et al. v. United States Department of Health and Human Services, Case No. 6:22-cv-450-JDK. These decisions vacated rules related to batching of IDR disputes, the administrative fee amount for IDR disputes, requirements related to the timeframe for sending an initial payment or notice of denial of payment, the methodology for calculating qualifying payment amounts (QPAs), and/or provisions pertaining to air ambulance disputes. Please review the opinions in the cases cited above for further information on which provisions of the regulations and guidance were vacated and the notes on our website about applicable guidance. Disregard those specific sections of this document to the extent inconsistent with the court’s opinions.)

July 28, 2022

On July 26, 2022, the U.S. District Court for the Eastern District of Texas issued a judgment and order in LifeNet, Inc v. United States Department of Health and Human Services (LifeNet), vacating the final sentences of 45 CFR 149.520(b)(2), 26 CFR 54.9817–2T(b)(2), and 29 CFR 2590.717–2 (b)(2), which are parallel provisions governing the Federal Independent Dispute Resolution (IDR) process applicable to air ambulance payment disputes. The sentence the court vacated states, “This information must also clearly demonstrate that the qualifying payment amount is materially different from the appropriate out-of-network rate.”

As a result of the LifeNet decision, effective July 26, 2022, certified IDR entities may not apply the vacated standard in reaching a payment determination in any payment dispute related to air ambulance services. The Departments are directing certified IDR entities to comply with the court’s judgment and order and are in the process of updating Federal IDR program guidance and related documents to make them consistent with the LifeNet decision. The Departments will issue these updates in the near future.

February 28, 2022

The Federal Independent Dispute Resolution (IDR) system is live. Due to a pause in the launch required to address a court ruling (see February 28 guidance (PDF)), there may be a backlog of Federal IDR requests and high initial case volume. This could cause delays in Federal IDR request processing. In response, the Departments will:

• Grant requests for extensions submitted by the parties or certified IDR entities, as appropriate.
• Monitor the volume and provide additional guidance, including updates to the timeframes under the Federal IDR process, as necessary. Updates will be announced here, and parties with disputes in process will be notified directly in advance of an update taking effect.