Advanced Explanation of Benefits
Requirements Related to Surprise Billing, Part II
- Calendar Year 2023 Federal IDR Process Fee Guidance
- Final Rule (Downcoding Disclosure and IDR Process)
- Affordable Care Act Implementation FAQs Part 55
- Fact Sheet
- Federal Independent Dispute Resolution Process Status Update
- News release
- Federal Independent Resolution Process Portal – The Federal Independent Dispute Resolution (IDR) system (Federal IDR Portal) is live and available to receive requests for resolution of payment disputes for certain out of network health care items and services. You can initiate a Federal IDR request here: https://nsa-idr.cms.gov/paymentdisputes/s/
- Federal Independent Dispute Resolution (IDR) Process Guidance for Certified IDR Entities (Updated 10/07/2022) -- This document provides guidance to certified IDR entities with an overview of the IDR process and their responsibilities as part of the process. You can access the guidance at: https://www.cms.gov/cciio/resources/regulations-and-guidance/downloads/federal-independent-dispute-resolution-process-guidance-for-certified-idr-entities.pdf
- For all items and services furnished on or after October 25, 2022 for plan years beginning on or after January 1, 2022: https://www.cms.gov/files/document/rev-102822-idr-guidance-certified-idres.pdf
- Federal Independent Dispute Resolution (IDR) Process Guidance for Disputing Parties (Updated 10/07/2022) -- This document provides information on how the disputing parties engage in open negotiation prior to the Federal IDR Process, initiate the Federal IDR Process, select a certified IDR entity, and meet the requirements of the Federal IDR Process. You can access the guidance at: https://www.cms.gov/files/document/federal-independent-dispute-resolution-guidance-disputing-parties.pdf
- For all items and services furnished on or after October 25, 2022 for plan years beginning on or after January 1, 2022: https://www.cms.gov/files/document/rev-102822-idr-guidance-disputing-parties.pdf
- Memorandum Regarding Continuing Surprise Billing Protections for Consumers
- Interim Final Rule with Request for Comments
- Petition Process for Certification of IDR Entities
- News Release
- Calendar Year 2022 Federal IDR Process Fee Guidance
- CMS External Review Guidance Regarding State Process
- Information collection documents associated with Federal independent dispute resolution process requirements
- Paperwork Reduction Act Supporting Statement for Federal Independent Dispute Resolution Process
- Open Negotiation Period Notice
- Notice of IDR Initiation
- Notice of IDR Entity Selection
- Notice of Agreement on an Out-of-Network Rate
- Notice of Offer
- IDR Certification Application
- Petition for Certification Denial or Revocation
- Monthly IDR Entity Reporting Requirements
- Request for Extension Due to Extenuating Circumstances
- Certified IDR Entity Written Determination
- Information collection documents associated with external review requirements
Provider Nondiscrimination
Group Health Plan Service Provider Disclosures Under ERISA Section 408(b)(2)(B)
Prescription Drug and Health Care Spending
- Prescription Drug Data Collection (RxDC) FAQs
- RxDC reporting instructions
- RxDC templates and data dictionary
- RxDC drug name and therapeutic class crosswalk
- Interim Final Rule
- News Release
- HHS Fact Sheet
Requirements Related to Air Ambulance Services, Agent and Broker Disclosures, and Provider Enforcement
No Surprises Act Implementation FAQs
Requirements Related to Surprise Billing, Part I
- Final Rule (Downcoding Disclosure and IDR Process)
- Fact Sheet
- News release
- Interim Final Rule with Request for Comments
- Model Notice
- HHS Guidance on Model Notice
- Fact Sheet for Consumers
- Fact Sheet for Group Health Plans and Health Insurance Issuers
- HHS News Release