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Policy Updates

11-22-23 Update: TMA III & IV Ruling – How to Proceed 

By November 22, 2023March 18th, 2024No Comments

After the reopening of the portal parties were asked to submit all disputes that would have been submitted during the pause, as well as, keep up with current submissions.

FHAS has been working diligently through all of our assigned disputes and determining eligibility as quickly as possible. As a result, parties have been receiving a large quantity of offer and payment requests that are due on the same day. We have received extension requests for these offers and payments as parties do not have the capacity to handle the number of disputes we are requesting. The entities received confirmation from CMS that we can provide extensions for offer and payments up until January 17th, 2024 due to these extenuating circumstances.

If you are a party who is unable to keep up with the volume of requests you are receiving from FHAS, please reply to this email with;

  1. Dispute numbers you would like an extension for or FHAS can access these disputes ourselves if you provide the email associated with your disputes, their due date, and how many you would like to extend.
  2. The reason for extension; staffing shortage, overwhelming number of disputes, etc.

Entities were also given the option to extend the deadline for additional information requests. If you are receiving addition information requests faster than you can answer them reply to this email and we will grant extensions.  

There are no other updates at this time.

With all of this information entities and providers are limited to the following:

Entity Capabilities

  • Able to resume the regular Notice of Offer request and payment determination processes for single/ bundled disputes.
  • Sending updated invoices and links for single/bundled disputes.
  • Status Updates for single/bundled disputes.
  • Processing withdrawals for single/bundled disputes.
  • Providing documents uploaded to the portal for single/bundled disputes. 

Entity Incapabilities

  • Reviewing any batched disputes.

*FHAS has zero access to batched disputes. 

Provider Capabilities

  • Initiating single/bundled disputes.

Provider Incapabilities

  • Initiating disputes for Air Ambulance Services.
  • Initiating batched disputes.

*CMS did not provide a timeline for when these initiations will be possible. 

Other Important Notes:

  • CMS has not released official guidance on forthcoming batching guidelines.
  • The TMA III order vacated certain provisions of the regulation establishing the methodology for calculating the Qualifying Payment Amount (QPA). The Departments issued guidance on how to proceed with disputes following the court’s order,

[Payment disputes between providers and health plans | CMS]

More Resources

Following the parties’ receipt of CMS’ email, FHAS attended a meeting with CMS(along with all other entities) to receive the official update of the portal reopening. In this meeting we received some useful FAQ’s:

October 2023 FAQs about Consolidated Appropriations Act, 2021 Implementation Part 62 (FAQs Part 62)

October 2023 Partial Reopening of Dispute Initiation Guidance FAQs

August 2023 Administrative Fee FAQs

FHAS will continue to update you as we find out new information.

If you have questions feel free to comment below, email or call FHAS at (570) 779-5122 and ask for our IDR department. Thank you.

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