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How to Choose an Impartial IDRE: A Guide for Providers and Payers

By April 19, 2024May 2nd, 2024No Comments

The impartiality of an Independent Dispute Resolution Entity (IDRE) is crucial for a fair and successful dispute resolution process. At FHAS, we understand the importance of independence, transparency, and timely determinations. We want to empower businesses to make informed decisions.

This guide explores key indicators to assess the impartiality of an IDRE:

1. Independence and Neutrality:

  • No Affiliation: The IDRE should have no financial or other ties to the parties involved in the dispute.
  • Balanced Roster: The IDRE’s pool of arbitrators or mediators should be diverse and not favor any specific industry or party type.
  • Disclosure Policies: The IDRE should have strong policies requiring arbitrators and mediators to disclose any potential conflicts of interest before being assigned to a case.

2. Code of Ethics and Standards:

  • Choose an IDRE that adheres to a strict code of ethics emphasizing impartiality, fairness, and neutrality.
  • These codes often include guidelines on disclosing conflicts and handling potential bias.

3. Transparent Processes:

  • Clear Procedures: The IDRE should have clear and publicly available procedures for:
    • Selecting arbitrators or mediators
    • Conducting hearings or mediation sessions
    • Issuing decisions
    • Handling appeals (if applicable)
  • Neutral Rules: The IDRE’s dispute resolution rules should be fair and unbiased, ensuring both parties have equal opportunities to present their case.

4. Training and Qualifications:

  • Training and Experience: Arbitrators and mediators should be well-trained and experienced in conflict resolution techniques and relevant laws and regulations. 
  • Look for expertise in healthcare reimbursement, medical claims reviews, coding expertise, surprise billing arbitration, and lengthy experience with government-sponsored healthcare programs 
  • Continuing Education: The IDRE should encourage ongoing training for its arbitrators and mediators to ensure they stay up-to-date on best practices.

5. Accountability and Oversight

  • Code of Ethics: The IDRE should adhere to a strict code of ethics that emphasizes impartiality, fairness, and neutrality.
  • External Review: Some IDREs are subject to external oversight by regulatory bodies, professional associations, or government agencies. This oversight provides an additional layer of assurance regarding adherence to fairness standards.
  • Feedback Mechanisms: The IDRE should have a system for collecting feedback from parties who have participated in the dispute resolution process. This feedback can be used to identify and address any potential issues with fairness.

6. Timeliness:

  • Choose an IDRE with a proven record of timeliness and efficiency in handling IDR cases 
  • The IDRE should adhere to the government’s timely adjudication standards of 30 business days to render a payment determination 

FHAS is committed to providing a neutral and impartial platform for businesses to resolve disputes. 

The FHAS Difference

  • Highly trained and experienced arbitrators with an average of 10+ years of expertise in arbitrating claims
  • Diverse arbitration pool capable of handling surges in case volumes
  • Rigorous Conflict of Interest Screening and Attestation Process to rule out any potential conflicts in arbitrating claims 
  • Industry Leaders in Healthcare claims adjudication
  • Timely adjudications within the federally mandated timelines
  • Over 100,000 payment determinations issued

Contact us today to learn more about our IDRE services.

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800-664-7177 (Toll-Free)