No Surprises Act

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How to File

Independent Dispute Resolution (IDR) serves as a method to settle payment disagreements between healthcare providers and health plans, aligning with the CMS No Surprises Act. The objective of the IDR procedure is to offer an unbiased judgment on equitable payment, all while excluding patients from the proceedings and shielding them from unexpected medical bills related to out-of-network services.

The IDR process involves the following steps:

STEP 1

Initiating a Dispute:

  • When initiating a dispute in the CMS Portal, the initiating party selects an Independent Dispute resolution entity (IDRE) from the dropdown menu (e.g. Select “Advanced Arbitration”)

  • The non-initiating party can agree or disagree with the selected IDRE (E.g “Advanced Arbitration”)

  • If parties cannot agree on an IDRE within 3 days, an IDRE is randomly assigned by the Departments from the remaining eligible options.

  • If one party doesn’t respond, the opposing party’s selected IDRE is assigned.

STEP 2

IDRE Assignment Notification:

  • The CMS Portal sends both parties an email notifying them of the assigned IDRE.

  • Once both parties receive an email regarding the assigned IDRE, the IDRE receives the dispute.

STEP 3

Objecting to Eligibility/Documentation:

  • Objections to eligibility should be submitted in the IDRE Selection Response Form; Objections should not be made after the selection of the IDRE.

  • If the eligibility documentation is not available when the IDRE is assigned the dispute, Advanced Arbitration will request required eligibility documentation from the parties.

  • The Non-initiating parties must provide documentation supporting their eligibility objections

  • If Advanced Arbitration has requested an offer and payment, but a party believes a dispute is ineligible, it is recommended to still submit payment and an offer while eligibility is determined to avoid default determinations.

  • Advanced Arbitration can only make an eligibility decision based upon the parties’ submitted documentation.

STEP 4

Requests for Payment and Offer:

  • Once a dispute is determined eligible, Advanced Arbitration will request payment via email (an email invoice).

  • Payments can be made via ACH, check, credit card.

  • Additionally, the federal IDR portal will send an email to the parties notifying them that an offer is due; the email will contain a link by which a party can submit an offer and supporting offer documents

  • Offer submission requests are sent on the same day as payment requests.

STEP 5

A Rendered Decision:

  • Once the timeline to submit payment and offer has ended, Advanced Arbitration proceeds with the appropriate resolution for the dispute.

  • Once the dispute is resolved, parties will be notified by Advanced Arbitration and the CMS via email correspondence of the outcome.

Reporting Any Issues:

Parties can contact the Advanced Arbitration communication team regarding any concerns with the dispute review process.