Recently, the Departments of Health and Human Services, Labor and the Treasury (collectively, the “Departments”) issued an extension for health care providers impacted by the Change Healthcare cyberattack to submit out-of-network payment disputes through the federal No Surprises Act (“NSA”) independent dispute resolution (“IDR”) process.
The NSA IDR process permits providers and facilities that are prohibited from balance billing for out-of-network services to dispute payments or denials made by health plans to an independent third party (the “Certified IDR Entity”). For a more detailed discussion of the NSA IDR process, please see our previous article here.
Under the NSA, an out-of-network provider has 30 days from receipt of initial payment or denial to initiate the IDR process. However, the Change Healthcare cyberattack impacted a large number of out-of-network payments (or denials) issued by health plans, potentially making it difficult for out‑of-network providers and facilities to receive all of the necessary information to initiate the IDR process within the mandated 30-day period. Recognizing this, the Departments have opened a special extended period during which providers and facilities impacted by the Change Healthcare cyberattack can submit those claims affected by the cyberattack for disputes through the IDR process. Specifically, if a provider completes an attestation providing that the Change Healthcare cyberattack impacted their ability to timely initiate the federal IDR process, then such provider will be able to submit any impacted claims for dispute within a special 120-day calendar period beginning June 14, 2024, and ending October 12, 2024. Note, health plans who believe that certain claims should not be eligible for this special extension period are also permitted to submit documentation to a Certified IDR Entity disputing the claim’s eligibility for this special extension period.
Providers and facilities that may have had claims payments impacted by the Change Healthcare cyberattack should take time to review the impacted claims payments and/or denials to determine if any of such claims may be eligible to be submitted for dispute through this special IDR extension period.
For more information on surprise billing or the federal IDR extension, please contact:
- Lisa Lucido at (248) 457-7812 or llucido@hallrender.com;
- Matthew Reed at (317) 429-3609 or mreed@hallrender.com; or
- Your primary Hall Render contact.
Special thanks to Meredith Johnson-Monfort, Summer Associate, for her contributions to this article.
Hall Render blog posts and articles are intended for informational purposes only. For ethical reasons, Hall Render attorneys cannot—outside of an attorney-client relationship—answer an individual’s questions that may constitute legal advice.
