Licensed IDR Entities to Resume Fee Determinations for Companies Furnished Earlier than October 25, 2022

the Departments directed Licensed IDR Entities to carry all pending cost determinations 2023

Earlier at this time, the Division of Labor, the Treasury, and the Division Well being and Human Companies Facilities for Medicare and Medicaid Companies (the “Departments”) issued a new directive to Licensed Unbiased Dispute Decision (IDR) Entities relating to issuing cost determinations for sure pending out-of-network (OON) disputes.

Efficient February 27, 2023, Licensed IDR Entities will resume issuing cost determinations for disputes associated with companies and gadgets furnished previous to October 25, 2022.

The announcement comes simply two weeks after the Departments directed Licensed IDR Entities to carry all pending cost determinations, in mild of the U.S. District Courtroom for the Jap District of Texas’ opinion on February 6, 2023, within the matter of Texas Medical Affiliation, et al. v. United States Division of Well being and Human Companies, Case No. 6:22-cv-372 (TMA II), which vacated particular guidelines governing the Federal IDR decision-making course of for disputes associated to OON suppliers, amenities and air ambulance suppliers. In that February 10, 2023 directive, the Departments additionally instructed Licensed IDR Entities to recall all cost determinations issued on or after February 6, 2023.

Licensed IDR Entities will quickly resume processing disputes for dates of service previous to October 25, 2022 – dates that correlate to time durations not affected by TMA II and the regulatory provisions that have been vacated. Licensed IDR Entities are directed to confer with the Departments’ beforehand issued steerage for resolving disputes. The steerage is offered right here: Federal Unbiased Dispute Decision Course of Steerage for Licensed IDR Entities (

IDR cost determinations for companies and gadgets furnished on or after October 25, 2022, are nonetheless on maintenance, pending extra steerage from the Departments.

In at this time’s announcement, the Departments additionally reminded events that the Federal IDR eligibility, timelines for open negotiation and initiation of IDR, and different elements of the IDR course haven’t been modified.

When you have questions on eligibility for the Federal IDR course of, or about different No Surprises Act necessities, the well-being care workforce at Sheppard Mullin can be glad to help you… LEARN MORE


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