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 work to determine an appropriate payment amount.

How can my organization apply?

Organizations interested in being certified to conduct arbitration in the independent dispute resolution process will need to apply online and submit documentation to show they have the experience and staffing to adjudicate cases fairly and impartially.

When is the deadline?

The application process opened September 30, 2021, and will remain open to accept applications on a rolling basis. 

What does my organization need to qualify?

As a part of the application process, organizations must:

Demonstrate expertise in these areas:

• Arbitration and claims administration
• Managed care
• Billing and coding
• Medical
• Legal (including healthcare law)

Be prepared to 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

Apply to become certified

Complete an application form that’s quick, easy, and lets you submit your full application right away. You’ll need to have all of your documents ready and you won’t be able to save your work. 

Watch this 1-hour video to learn more about how to become a certified independent dispute resolution entity.

Have all of your documents ready?
Start application

Have questions? Email us at FederalIDRQuestions@cms.hhs.gov