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The Department of Health and Human Services (HHS), the Department of Labor, and the Department of the Treasury (collectively, the Departments) have completed their review of the certification applications and determined that Physio Solutions LLC and Intel Care IPA meet the minimum qualification standards for certification as Independent Dispute Resolution (IDR) entities. Members of the public, including providers, facilities, providers of air ambulance services, and plans or issuers, can submit a petition for the denial of IDR entity certification within five business days of the public announcement. After reviewing any petitions received, the Departments will make a final decision on certification.
The No Surprises Act, which created new protections against out-of-network balance billing, established a Federal IDR process that out-of-network providers, facilities, providers of air ambulance services, plans, and issuers in the group and individual markets may use to determine out-of-network rates for applicable items or services after an unsuccessful open negotiation. During the Federal IDR process, disputing parties select a third-party arbitrator, known as a certified IDR entity, to resolve their dispute. These arbitrators go through a rigorous certification process so that the Departments can ensure they are able to adjudicate disputes fairly and impartially.
Additional resources:
Federal IDR team
Center for Consumer Information and Insurance Oversight (CCIIO)
Department of Health and Human Services
Centers for Medicare & Medicaid Services
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