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Mar '22 Agencies Issue FAQs on No Surprises Act Dispute Resolution

Business Insurance

Agencies Issue FAQs on No Surprises Act Dispute Resolution

In February 2022, the Departments of Labor (DOL), Health and Human Services (HHS) and the Treasury (Departments) issued FAQs to provide more guidance on the Federal Independent Dispute Resolution (IDR) Process under the No Surprises Act (NSA), enacted as part of the Consolidated Appropriations Act, 2021 (CAA).

These FAQs address:
  • IDR entity qualifications and the application process;
  • Fees; and
  • The Federal IDR Process.

The NSA prohibits “surprise billing,” or instances in which an individual receives an unexpected bill after obtaining items and services from an out-of-network provider or facility, when the individual did not have the opportunity to select a facility or provider covered by their health insurance network (such as during a medical emergency). The NSA provides for a Federal IDR Process to resolve payment disputes after unsuccessful negotiation, where a certified IDR entity will review the specifics of the case and services received and determine the final payment amount.

The Departments previously issued guidance on the Federal IDR Process in the form of a Process Guide. This guide provides information for certified IDR entities on various aspects of the Federal IDR Process. It includes information on how the parties to a payment dispute may initiate the Federal IDR Process, as well as the requirements of the Federal IDR Process, including the requirements that certified IDR entities must follow in making a payment determination.

Additional articles from the March 2022 edition of the Univest Employee Benefits Newsletter:
  1. Benefits Offerings to Avoid the Great Resignation
  2. Understanding the Value of a Learning Culture
  3. Managing the Excuse-Makers

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