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March 24, 2023

HHS Issues New Guidance to IDR Entities Following No Surprises Act Order

On March 17, 2023, CMS instructed certified independent dispute resolution (“IDR”) entities to resume adjudicating out-of-network payment disputes over services furnished on or after October 25, 2022 under the federal No Surprises Act’s IDR process. As  widely reported, there is a significant backlog of payment disputes because there have been far more IDR requests than were originally anticipated, and the IDR process was halted again as a result of the U.S. District Court for the Eastern District of Texas order in Texas Medical Association v. United States Department of Health and Human Services, Case No. 6:22-cv-372 (E.D. Tex. Feb. 6, 2023) that invalidated parts of the multi-agency final rule implementing the IDR process. CMS said in the new notice that the relevant Departments had finished updating the Federal IDR portal and Federal IDR process guidance documents to reflect the revisions to the payment determination standards as ordered by the court.  

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