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How to Make Your IDR Documentation Stronger

By June 4, 2024No Comments

The most important factor impacting an Independent Dispute Resolution (IDR) entity’s determination is the accuracy and completeness of each party’s documentation. An arbitrator considers only the information provided in each dispute and cannot independently investigate a claim. Under the No Surprises act, an arbitrator must select an offer submitted by either the initiating party or the non-initiating party. Certified IDR entities do not have the authority to create a wholly unique payment amount to substitute in place of a submitted offer. 

To properly initiate and support their case in an independent dispute resolution (IDR) under the No Surprises Act, the parties (provider/facility and health plan) will typically need to provide the following documentation:

Some states have issued their own guidance requiring additional documentation for IDRs involving their health plans/providers, such as whether certain self-insured plans are applicable to the state or federal IDRE process. 

  • 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

See How to File for a detailed walkthrough of the process.

Comment below: Was this helpful? What other questions can we help answer?

As always, feel free to contact our team via chat, email IDRE@fhas.com, or call 800-664-7177, and our IDRE service team can answer your immediate questions.

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