IDR Portal and Machine-Readable Files FAQ
On Friday, April 15, the Center for Medicare & Medicaid Services (CMS) launched the online IDR portal. The portal is a tool available to nonparticipating providers and health plans, after a 30-business day open negotiation period, when they are not able to agree on the out-of-network rate for services provided. The process is a part of the new consumer protections against surprise out-of-network balance billing, effective January 2022, under the No Surprises Act (NSA).
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Court Ruling on No Surprises Act Independent Dispute Resolution Procedures
On Feb. 23, 2022, the U.S. District Court for the Eastern District of Texas granted a motion for summary judgment in favor of the Texas Medical Association (TMA), which contended that the Independent Dispute Resolution (IDR) process laid out in the Interim Final Rule Part II conflicted with the No Surprises Act’s statutory requirements.
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End of 2021 Compliance Update
WebTPA is committed to keeping its clients up to date on federal healthcare policies and legislation. Below are two updates to kick off 2022.
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No Surprises Act Status Update
As we enter the second month of 2022, we are sharing a status update on continued compliance efforts related to No Surprises Act and other regulatory requirements and recent notices.
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Federal Legislation for Self-Funded Health Plans
WebTPA is committed to keeping its clients up to date on federal healthcare policies and legislation. Here you will find our interpretation of said legislation and how these statutes may impact your health plan.
Publicly Available, Machine-Readable Files
In-Network Rates and Historical Out-of-Network Allowed Amounts
To meet transparency requirements effective July 1, 2022, WebTPA will assist plan sponsors in making the two machine-readable files available (in-network rates for covered services or item covered by the plan, historical billed charges from out-of-network providers and the allowable amount of such charges considered by the plan).
Important Note
These are very large JavaScript Open Notation (JSON) files (20GB to 70GB) that may take a while to download. If your system has limited capability, they may not be downloadable. Download speeds and time are dependent on your internet speed, browser and computer hardware.
