IDR payment determinations resuming for services provided on or after Oct 25, 2022
Monday, March 20, 2023
AAMS Member Alert - March 20, 2023
On Friday, March 17th, the Departments of Health and Human Services, Labor, and the Treasury instructed certified IDR entities to resume making payment determinations for disputes involving items or services furnished on or after October 25, 2022. The standards governing a certified IDR entity’s consideration of information when making payment determinations in these disputes are provided in the Requirements Related to Surprise Billing; August 2022 final rules, as revised by the opinion and order of the U.S. District Court for the Eastern District of Texas in TMA II.
Guidance for certified IDR entities’ payment determinations for items and services furnished on or after October 25, 2022 is posted here: https://www.cms.gov/files/document/federal-idr-guidance-idr-entities-march-2023.pdf.
Updated guidance to disputing parties regarding disputes involving items and services furnished on or after October 25, 2022 is posted here: https://www.cms.gov/files/document/federal-idr-guidance-disputing-parties-march-2023.pdf.
Also starting March 17, 2023, disputing parties will begin receiving a majority of their payment determination notices from the IDR portal, specifically from auto-reply-federalidrquestions@cms.hhs.gov. CMS asks disputing parties to make note of this email address.
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