How To Make Your IDR Documentation Stronger

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 — meaning, the information each party provides and the QPA is the only information considered in their review.

While providers and health plans should ensure they include comprehensive documentation, only pertinent documentation should be included, narrowing it down to only what is clearly relevant to the specific case. Burying the arbitrator in irrelevant information only makes it difficult to sift out the pertinent details.

It’s also important to note that 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 or facility and the health plan) will typically need to provide the following documentation:

IDR Initiation Notice Evidence of Good Faith Negotiation Attempt Copies of Relevant Plan Documents Proof of Payment/Remittance Advice Medical Records/Treatment Details Provider Credentials and Qualifications Previously contracted and/or negotiated rates Complicating Factors Documentation State-Specific Documentation Requirements Notice of Offer Form

It’s important to note that some states have issued their own guidance requiring additional documentation for IDRs involving their health plans and providers, such as whether certain self-insured plans are applicable to the state or federal IDRE process.

By presenting a well-documented case, you increase your chances of a favorable determination.

If you are ever interested in understanding the reasoning behind the determinations reached or wish to review the opposing party’s documentation, you can request this information from our team at idre@fhas.com. We are here to assist you in navigating the IDR process and ensuring your submissions are as robust as possible.

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

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

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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