Help resolve payment disputes

Apply to become a certified Independent Dispute Resolution Entity

CMS is looking for organizations to assist in the billing dispute resolution process between providers or facilities and health plans. When a provider or facility and a health plan can’t agree on the payment amount for an out-of-network service covered by No Surprises rules, these organizations will determine the payment amount.

Organizations interested in being certified to conduct arbitration in the independent dispute resolution process will need to apply and submit documentation to show they have the experience and staffing to adjudicate cases fairly and impartially. The application process is now open starting September 30 and will remain open to accept applications on a rolling basis. Organizations must submit the application and all documentation no later than November 1, 2021, to be certified by January 1, 2022, to perform payment dispute resolutions between health plans and providers or facilities for certain out-of-network services experienced by patients.

As a part of the application process, organizations must:

  • Demonstrate expertise in:
    • Arbitration and claims administration
    • Managed care
    • Billing and coding
    • Medical
    • Legal (including healthcare law)
  • Submit the following documentation:
    • Organization structure and staffing plan
    • Conflict of interest attestation
    • Indicators of fiscal integrity
    • Internal controls to hold fees
    • Fee schedule
    • Proof of accreditation or arbitration training
    • Process to maintain the confidentiality of individually identifiable health information
    • Internal controls to support reporting compliance
    • Policies and procedures for ensuring subcontractor compliance

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Page Last Modified:
09/30/2021 04:02 PM