New Proposed Rule on No Surprises Act’s Independent Dispute Resolution (IDR) Process

The Departments of Health and Human Services (HHS), Labor, and Treasury (the Departments) released a proposed rule on the No Surprises Act’s (NSA) federal independent dispute resolution (IDR) process to allow providers, facilities, and health plans to resolve payment disputes for certain out-of-network charges.

The No Surprises Act prohibits providers from charging patients more for out-of-network emergency services, or for services performed by an out-of-network physician at an in-network facility. The proposed rule would require payers to provide additional information at the time of initial payment or notice of denial of payment and to use standardized codes to communicate whether a claim for an item or service furnished by an out-of-network provider or facility is or is not subject to the NSA’s surprise billing provisions and the federal IDR process. The proposed rule also outlines additional parameters for the IDR process itself and a process whereby qualified IDR items and services would be batched in order to address the unique circumstances of certain medical specialties and provider types.

The proposed rule has a 60-day public comment period.