CMS: IDR Portal Notice of Initiation Submission New Document Requirements Reminder

AAMS Member Alert: November 30, 2022

AAMS received the following notice from the Centers for Medicare and Medicaid Services:

CMS: IDR Portal Notice of Initiation Submission New Document Requirements Reminder

On the evening of Tuesday, November 29th, the updated Notice of Initiation form was released on the Federal Independent Dispute Resolution (IDR) portal.

Users accessing the Federal IDR portal for the first time after the deployment must clear the computer’s cache or open a private or incognito window to access the updated IDR initiation form.

The updated Notice of Initiation requires a party seeking to initiate a payment dispute through the Federal IDR portal to include specific documentation with the notice of initiation submission. Specifically, any party initiating a payment dispute must now upload the following:

1. Documents to confirm the open negotiation period start date (for example, the notice of open negotiation).
2. Documents to confirm the claim and Qualifying Payment Amount information (i.e., the notices associated with the initial payment or notice of denial of payment such as the explanation of payment).

Additionally, any party that enters an open negotiation start date more than 34 business days earlier than the date on which the form was completed must now upload documents to confirm that the claim is still eligible for the Federal IDR process. The initiating party must upload at least one of the following:

1. Documents to confirm an approval of an extenuating circumstance extension from the federal IDR mailbox.
2. Documents to confirm the certified IDR entity’s request to re-submit the dispute due to batching or bundling errors.
3. Documents to confirm the 90-day cooling off period has expired.

An entity that does not upload the required documentation will not be able to submit the notice of IDR initiation.

These changes are reflected in the IDR Notice of Initiation Web Form Job Aid, found at the following link: https://www.cms.gov/files/document/idr-notice-initiation-job-aid.pdf

To start a payment dispute, go to the following link: https://nsa-idr.cms.gov/paymentdisputes/s/

If a plan or issuer fails to make a required disclosure in a document, that doesn’t stop a provider from initiating a dispute. The provider should upload the document they received (e.g., remittance or explanation of payment) even if the payer failed to make the required disclosure on the document and can still initiate the dispute.

Nothing related to this requirement conflicts with the answer to Question 20 in the FREQUENTLY ASKED QUESTIONS ABOUT AFFORDABLE CARE ACT AND CONSOLIDATED APPROPRIATIONS ACT, 2021 IMPLEMENTATION PART 55 published in August which can be found at the following link: https://www.dol.gov/sites/dolgov/files/EBSA/about-ebsa/our-activities/resource-center/faqs/aca-part-55.pdf

For more information about the federal IDR dispute process, go to the following link: https://www.cms.gov/nosurprises/help-resolve-payment-disputes/payment-disputes-between-providers-and-health-plans