On December 23, 2022, the Departments of Health and Human Services (HHS), Labor and the Treasury (collectively, the departments) published an amendment to the Calendar Year 2023 Fee Guidance for the Federal Independent Resolution Process under the No Surprises Act, which was previously published October 31, 2022. We covered this original guidance in our November 8, 2022, edition of Compliance Corner.
The original guidance provides information on the federal independent dispute resolution (IDR) process, which includes information for group health plans and insurers who are seeking to resolve a payment claim for items and services covered by the surprise billing protections under the No Surprises Act (NSA) of the Consolidated Appropriations Act, 2021 (CAA, 2021). Under the rules, each party must pay a non-refundable administrative fee for participating in the federal IDR process. The administrative fee is established annually to offset the estimated costs to the departments to carry out the federal IDR process for the year.
The 2023 guidance originally stated the administrative fee would remain $50 per participating party. This amendment increases the 2023 fee to $350 per party for disputes initiated during the 2023 calendar year. The rationale for the increase is that a significant backlog of disputes is expected to grow in 2023. The departments have engaged a contractor and government staff to conduct pre-eligibility reviews, which will come at an increased cost to the federal IDR process. The amended guidance also restates but does not change, the allowable ranges for certified IDR entity fees related to determinations in 2023, which remains $200-$700 for single determinations, or $268-$938 for batched determinations, unless otherwise approved by the departments.
Employers that sponsor group health plans, particularly those that sponsor self-insured plans, should be aware of the updated federal IDR process guidance document.
HHS Updated IDR Fee Guidance »
PPI Benefit Solutions does not provide legal or tax advice. Compliance, regulatory and related content is for general informational purposes and is not guaranteed to be accurate or complete. You should consult an attorney or tax professional regarding the application or potential implications of laws, regulations or policies to your specific circumstances.
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