FHAS Determinations Without Payment From Carriers
Recouping Delinquent Payments after an IDR Determination
The role of a certified IDR entity under the No Surprises Act is to choose from the two competing payment offers submitted by each party to the dispute. This decision must occur within 30 business days of finalization of the selection of the entity, which is when the entity testifies to no conflict of interest. When a determination is made the entity will notify the plan, provider, facility, or provider of air ambulance services, as well as the Departments.
The determination of the IDR entity is legally binding unless there is fraud or evidence of intentional misrepresentation of material facts to the entity by any party regarding the claim.
Unfortunately, we know that prevailing parties often encounter trouble receiving their awarded amount post-determination because the non-prevailing parties drag it out, ignore the request or deny having to owe the amount.
While FHAS, as a certified IDR entity, has no authority to enforce a payment determination, we recognize the frustration that results from when non-prevailing parties fail to meet their responsibilities under the No Surprises Act.
Payment is Due 30 Calendar Days after Determination
If it has been more than 30 Calendar days (not business days) since we selected your payment offer and the decision resulted in a balance owed to you, there are steps you can take to resolve an unpaid item dispute.
Submit a Billing Complaint to CMS
CMS enforcement actions are triggered by submitting a billing complaint via this online complaint form. Despite some confusion about the purpose of this form, it is not limited to provider complaints about entities. It also accepts complaints from either IDR party if they believe the opposing party is not complying with the IDR process.
Complaints can also be submitted via phone by calling 1-800-985-3059.
Submitting an official complaint allows CMS to start the enforcement investigation process and is an IDR party's best avenue to recoup an unpaid IDR determination.
FHAS Reports Unpaid Determinations
In an effort to minimize the number of delinquent determinations, the team at FHAS is also proactively monitoring and notifying CMS when large amounts of disputes rendered by our team have not been paid.
While arbitration under the No Surprises Act has been advantageous to payers, providers and patients, IDR is only effective when all parties abide by the guidelines.
FHAS will continue to add clarity and transparency to the IDR process whenever possible and for the benefit of all involved. If you have a question or concern about IDR with FHAS or complying with the No Surprises act, call 800-664-7177 now to connect with an experienced member of our team. For your convenience, we are also available via chat or by emailing idre@fhas.com.
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The information contained in this content piece is for general informational purposes only. While we strive to ensure the accuracy and completeness of the information presented, we make no representations or warranties of any kind, express or implied, about the accuracy, reliability, suitability, or availability with respect to the content or the information, products, services, or related graphics contained in the content piece for any purpose. Any reliance you place on such information is therefore strictly at your own risk. The content of this page is subject to change without notice. The information provided in this document does not constitute legal or other professional advice, and is non-binding upon FHAS and any federal government agencies.