Independent Dispute Resolution (IDR)

Currently Featured Client Services & Industry Solutions / Independent Dispute Resolution (IDR)

Navigating the Challenges of the No Surprises Act / IDR Dispute Process

The No Surprises Act (NSA) introduces new protections and a transparent framework for resolving out-of-network payment disputes, empowering health plans and providers to navigate these challenges via a multi-step process. The Independent Dispute Resolution (IDR) process, while vital for resolving out-of-network payment disputes under the No Surprises Act, comes with its own set of challenges:

• Email-Driven Communication: The reliance on email for submissions, responses, and updates can lead to tracking difficulties and potential delays.
• Varied Notification Templates: Differing formats and templates for notifications can create inconsistencies and increase the risk of errors.
• Complex Timelines: With multiple deadlines for negotiation periods, submissions, and responses, managing timelines requires meticulous attention to detail.

Managed by the Departments of Health and Human Services, Labor, and the Treasury, this system supports fair billing practices while striving to foster collaboration between health plans and care providers.

To ensure a seamless experience, health plans and providers must adopt proactive strategies, such as streamlining communication workflows, standardizing templates, and implementing robust tracking systems to stay on top of deadlines and deliver timely responses.

Value Proposition of a Trexin IDR Assessment, Recommendations, and Execution

When managing an influx of claim disputes, non-standard email notifications, and required actions based on varied deadlines with the focus on compliance and revenue cycle goals, it is best to reassess and redesign your NSA/IDR process.

Reviewing a difficult process requires a structured approach to identify inefficiencies, pinpoint root causes, and develop actionable solutions.

Here are the key assessment steps:

• Define the Process Scope and Objectives
• Map the Current Process
• Gather Stakeholder Input
• Analyze Data and Metrics
• Identify Bottlenecks and Challenges
• Evaluate Tools and Technology
• Assess Compliance and Risks
• Gather Best Practices and Benchmark
• Develop Recommendations
• Test and Refine
• Document Findings and Action Plan

Trexin can help you navigate and overcome the varied challenges in the IDR process with results focused on process efficiency, submission compliance, and financial success.