In a Dec. 21 final rule, the Department of Health and Human Services (HHS) finalized fees associated with the federal independent dispute resolution (IDR) process, which enables insurance plans and health care providers to settle disputes over appropriate payment for out-of-network services.
In an Aug. 3 decision, the U.S. District Court for the Eastern Division of Texas, Tyler Division vacated guidance HHS used to establish the administrative fee. Per the final rule, the administrative fee will be based on the projected total number of administrative fees paid to IDR entities, rather than the projected number of closed disputes. The administrative fee will be $115 per party for disputes initiated on or after the rule’s effective date, Jan. 22, 2024. This fee will remain in effect until HHS finalizes a different administrative fee amount in subsequent notice and comment rulemaking.
In response to the same court opinion, HHS is finalizing certified IDR entity fee ranges for single and batched determinations, rather than mixed fees. For disputes initiated on or after Jan. 22, 2024, a certified IDR entity fee may range from $200 to $840 for single determinations and $268 to $1,173 for batched determinations. For batched disputes exceeding 25 line items, IDR entities may set a fixed fee between $75 to $250 for each increment of 25 line items beginning with the 26th line item. These fees will remain in effect until HHS finalizes a different certified IDR entity fee amount in subsequent notice and comment rulemaking.
Both fees will be updated no more frequently than once a year.
Contact Senior Director of Policy Erin O’Malley at email@example.com or 202.585.0127 with questions.