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Policy Updates

11-30-23 Update: TMA III & IV Ruling – How to Proceed 

By November 30, 2023March 21st, 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.

From 11/29/23 – 1/16/24, the Departments have authorized extensions to certain IDR timelines. 

  1. Disputing parties may request and certified IDR entities may grant additional time to submit a Notice of Offer;
  2. Certified IDR entities may allow disputing parties additional time to respond to requests for additional information; and
  3. The certified IDR entity selection and reselection process will be extended to 10 business days, rather than 3 business days.

Source: Overview of rules & fact sheets | CMS

If you are a party who is unable to keep up with the volume of requests you are receiving from FHAS, please send an email to the IDRE with Extension Request in the subject line, as well as;

  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.

Please note, entities only have the capability to extend offer deadlines in 10-day increments. Also, extensions are a manual process, we have team members dedicated to providing extensions, but they do take time! All extension requests will be granted; however, it is not guaranteed you will receive it the day it is requested.

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 on this post, email us at or call FHAS at (570) 779-5122 and ask for our IDR department. Thank you.

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