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Chart Regarding Applicability of the Federal Independent Dispute Resolution Process in Bifurcated States

Aug 29, 2022, 11:45 AM by CMS

The No Surprises Act establishes a Federal Independent Dispute Resolution (IDR) process that providers, emergency facilities, and providers of air ambulance services and group health plans and health insurance issuers in the group and individual market, as well as Federal Employees Health Benefits carriers, may use following the end of an unsuccessful open negotiation period to determine the out-of-networkpayment amount for certain qualified IDR items and services

The Centers for Medicare & Medicaid Services (CMS) has released a chart outlining the IDR process for states that have a bifurcated process for services that may be subject to the Federal IDR process or may be subject to a specified state law or All-Payer Model Agreement.  

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