US HHS Finalizes Rule to Streamline No Surprises Act Dispute Resolution

US HHS Finalizes Rule to Streamline No Surprises Act Dispute Resolution

The U.S. Department of Health and Human Services (HHS) finalized a rule to streamline out-of-network payment disputes between providers and health insurers, aiming to cut administrative costs.

Key Details of the Rule

The rule reduces the administrative fee per dispute from $115 to $15 per party, potentially increasing participation. It also allows batching a reasonable number of claims together, reducing costs and speeding up decisions.

HHS will launch a new centralized platform to manage disputes in phases starting this year. The rule also requires payers to use standardized claim codes when communicating about out-of-network services, helping providers determine early whether a claim qualifies for the Independent Dispute Resolution (IDR) process.

About the No Surprises Act

Passed in 2020, the No Surprises Act protects patients from surprise medical bills that often arise when patients visit an in-network hospital but receive care from out-of-network doctors.