Administration issues surprise billing Independent Dispute Resolution Operations final rule

On May 28, HHS, the Department of Labor, and the Department of the Treasury (the Departments), along with the Office of Personnel Management, issued the Federal Independent Dispute Resolution (IDR) Operations final rule. Among other provisions, the new rule requires insurers to use standardized claim codes when communicating with out-of-network providers and permits a maximum of 50 qualified items and services to be resolved in a single dispute batch. HHS also provided more information related to the IDR Gateway, explaining that the platform’s features, such as in-portal negotiations, will begin rolling out soon.

Although HHS said the final rule is intended to streamline communications, processes, and timelines among providers, insurers, and certified IDR entities, the core issues with the No Surprises Act IDR process remain. The final rule does not change how IDR entities are paid today (which is based on issuance of determinations), so the IDR entity incentive to consider disputes eligible may persist. There is also no change to the consideration or weighting of the qualified payment amount in IDR. Moreover, the Departments are reducing administrative fees by more than 85%, which will make it easier for providers to file IDR disputes.