Apply to be certified
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 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.
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
- Legal (including healthcare law)
Submit this 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
There are 2 application options. A one-time application form that’s quick, easy, and lets you submit your full application right away. To apply this way, you’ll need to have all of your documents ready and you won’t be able to save your work. Alternatively, the new application option will let you save your progress and come back to complete it later. You’ll be able to log in to retrieve your application and see other statuses. To apply this way, you’ll need to register for an account.
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 one-time application
First, create an account with CMS and request access to the federal independent dispute resolution (IDR) portal (“Federal IDR Portal”). This process may take up to 48 hours.
Follow the registration instructions (PDF), to get started with creating an account and requesting the right access.
Log in to start or continue an application
Have questions? Email us at FederalIDRQuestions@cms.hhs.gov