Home > Legal Updates > Surprise billing arbitration system for out-of-network payment disputes goes live

Surprise billing arbitration system for out-of-network payment disputes goes live

The Departments of Health and Human Services, Labor and the Treasury (Departments) last week announced the opening of the federal Independent Dispute Resolution (IDR) system for initiating arbitration under the No Surprises Act process and updated their guidance to certified IDR entities for determining out-of-network payment amounts.

What is the No Surprises Act?

The No Surprises Act and related regulations protect patients from surprise medical bills for non-emergency services furnished by out-of-network providers at in-network healthcare facilities, emergency services, and out-of-network air ambulance services. If a provider and the health plan or insurer disagree on the payment amount for out-of-network services and are unable to resolve the dispute through negotiation then either party may initiate the IDR process within 4 business days after the end of the 30 business day negotiation period. A certified IDR entity will then be selected, the provider and the health plan or insurer will each submit a proposed payment amount and supporting information to the IDR entity, and the IDR entity will select one of the two offers as the out-of-network rate. Read more…