CMS Releases Petition Instructions for Entities Seeking IDR Certification

The Centers for Medicare and Medicaid (CMS) released instructions via their website for entities wishing to apply as a certified independent dispute resolution (IDR) entity. The IDR process, a product of the Consolidated Appropriations Act (CAA), is no joking matter. It is complex, requiring only Plans and Providers to negotiate disputed service fees, removing Plan participants from the fray. To learn more about the CAA’s IDR process, read our blog. 

Applying entities must meet the minimum qualification standards; if so, they will proceed to the public petition period. A list of eligible entities will be posted weekly, and will remain open for petitions for 5 business days. Excerpts from CMS’ website are below:

How to submit a petition

Members of the public, providers, facilities, providers of air ambulance services, plans or issuers, and state regulators can petition for the denial of the certification of an IDR entity.

• Petitioners must complete a petition form that identifies the IDR entity seeking certification, and outline the reasons for the petition.
• Petitioners will receive an emailed acknowledgement of the receipt of their petition within 10 days.
• After review, if the petition adequately shows a failure to comply with the requirements of the No Surprises Act, the IDR applicant will be notified.
• The applicant will then have the chance to provide a response, and a final decision will be made on certification.

Note: Petitions must be submitted during the 5-day petition window for applicants on that week’s list. After that week, feedback for those applicants closes, and a new 5-day petition window opens for different applicants.