Who to Contact for NSA IDR Issues: CMS or the IDR Entity?

Wondering who to contact for your IDR issues? This quick guide will direct you to the right contact for common concerns and requests for more information. Below we cover CMS forms issues, clarifications on dispute timelines, QPA calculation disputes, requests for documentation, fees, withdrawal requests, and extension inquiries.

Common NSA IDR Inquiries

1. Who can help with issues with IDR entity selection response forms?

For issues related to completing the CMS IDR entity selection, such as discrepancies or issues with selection forms, contact CMS directly at FederalIDRQuestions@cms.hhs.gov. 

The IDR entities do not have access to or control over the entity selection response forms and cannot address issues related to their completion. Only CMS manages and sends these forms, so they are your go-to resource for resolving any concerns in this area.

2. Who can help explain or clarify the NSA IDR timeline?

For detailed information or clarification on the IDR timeline, the IDR entity is your primary contact. They oversee the day-to-day management of disputes, including providing specific details about the timeline for each step of the process. 

If you need to understand the schedule or any time-related aspects of your dispute, the IDR contact can offer the most accurate and up-to-date information.

3. How do you dispute the QPA for NSA IDR claims?

For disputes or questions about the Qualifying Payment Amount (QPA) calculations, contact CMS directly at FederalIDRQuestions@cms.hhs.gov. Only CMS has the authority to determine whether the QPA has been accurately calculated by the health plan. 

IDR entities do not have the capability to adjust or review QPA calculations and are not involved in this aspect of the dispute.

4. Can you get access to the opposing party’s IDR claim documentation?

Yes. For access to dispute documentation, such as Explanation of Benefits (EOBs) or other relevant records, you should contact the IDR entity. They manage the documentation related to the dispute and can assist in obtaining these records if they have not been provided by the opposing party. Note that access to offer submission documents will be provided only after a determination has been made.

5. Who can help answer questions about IDR fees for No Surprises Act disputes?

For questions concerning IDR fees, you should contact the IDR entity. They manage the financial details related to the dispute process, including handling inquiries about fees and payment amounts. The IDR entity can provide specific information and address any concerns regarding the financial aspects of your dispute.

6. How do you withdraw an NSA IDR dispute or address settlement procedures?

To request the withdrawal of a dispute, reach out directly to the IDR entity. They handle the processing of withdrawal requests. If you reach a settlement prior to a determination being rendered, notify the IDRE with the signed agreement so the dispute can be withdrawn.

7. Who do I ask for an extension on my IDR claim?

For requests to extend the dispute process, contact CMS directly at FederalIDRQuestions@cms.hhs.gov. CMS will assess whether the request qualifies as an extenuating circumstance. If the request is approved, CMS will provide guidance, and the IDR entity will then grant the extension according to your specific situation. The IDR entity does not have the authority to approve extensions independently.

IDR Entity vs. CMS: Your Best Contact for IDR Questions/Concerns

FHAS is your trusted partner in Independent Dispute Resolution. Our team offers the experience and unparalleled service of the nation’s leading IDR-focused entity in the federal marketplace. If you have questions or want assistance getting in touch with CMS, you can always contact our team at 1-800-664-7177 or idre@fhas.com.