Federal Independent Dispute Resolution (IDR) Process

Under the Consolidated Appropriations Act, starting Jan. 1, 2022, consumers with health insurance won’t be responsible for balance bills or out-of-network cost sharing when receiving emergency care, non-emergency care from out-of-network providers at in-network facilities, or air ambulance services from out-of-network providers.

After an out-of-network provider or facility receives a payment or a notice of denial from HMSA, they can appeal the denial or negotiate the qualifying payment amount by submitting a notice for open negotiation within 30 business days.

If you wish to submit a notice for open negotiation, please contact Provider Contracting and Relations by emailing PSInquiries@hmsa.com.

If agreement can’t be reached during the open negotiation period, either party can begin the federal independent dispute resolution (IDR) process within four business days through the federal IDR portal and by submitting notice to Provider Contracting and Relations by emailing PSInquiries@hmsa.com.

For more information on the No Surprises Act and the federal IDR process, please visit cms.gov/nosurprises.

Additional Resources:

• Appealing Processed Claims
• Dispute Resolution (Appeals and Arbitration)
• Arbitration
• Physician Appeals
• Non-Physician Appeals
• Transparency in Coverage (TCR) and Consolidated Appropriations Act (CAA) Overview
• Requesting access to a Federal IDR Portal account [PDF]
• Standard Open Negotiation Form [PDF]
• Standard IDR Initiation Form [PDF]
• Model Disclosure Notice Regarding Patient Protections Against Surprise Billing [PDF]
• Standard Notice and Consent Surprise Billing Protection Forms for Nonparticipating Providers [PDF]

Revision History