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No Surprises Act Independent Dispute Resolution


*Today, the Departments of Health and Human Services, Labor, and the Treasury (collectively, the Departments) are announcing a 120-calendar-day exception period for disputing parties impacted by the recent Change Healthcare cybersecurity incident to initiate open negotiation for impacted items or services, beginning 6/14/2024 and ending 10/12/2024.*

The Departments are aware that Change Healthcare – a unit of UnitedHealth Group – was impacted by a cybersecurity incident in late February. The Departments recognize the impact this attack has had on health care operations across the country, including certain parties’ ability to initiate open negotiation, the initial stage of the Federal independent dispute resolution (IDR) process.

The Departments have received reports from providers, facilities, and providers of air ambulance services that they are unable to initiate open negotiation because they have not received necessary payment information or disclosures from plans or issuers due to disruptions to claims processing resulting from the Change Healthcare cybersecurity incident. In “FAQs About Affordable Care Act And Consolidated Appropriations Act, 2021 Implementation Part 55 [ https://www.hhs.gov/guidance/sites/default/files/hhs-guidance-documents/FAQs-Part-55.pdf ],” (FAQs Pt. 55) the Departments explained that if a plan or issuer fails to timely disclose the information it is required to with each initial payment or sending a notice of denial of payment[1] [ #_ftn2 ], providers, facilities, and providers of air ambulance services may request an extension to initiate the Federal IDR process by emailing a request for extension due to extenuating circumstances to FederalIDRQuestions@cms.hhs.gov. However, the Departments recognize that payment for a very large volume of items and services was impacted by the Change Healthcare cybersecurity incident, making individual extension requests burdensome for disputing parties and for the Departments. Additionally, the Departments understand that it may be difficult to determine the date of initial payment or notice of denial of payment for an item or service impacted by the cybersecurity incident, as in some cases, disruptions to payment transmissions have made it difficult to match payments received to specific items or services furnished.

Therefore, the Departments are announcing that providers, facilities, and providers of air ambulance services whose ability to timely initiate open negotiation for any item or service furnished on or after January 1, 2024, was impacted by the Change Healthcare cybersecurity incident may choose to initiate open negotiation for such items or services at any point during the 120-calendar-day period following the publication of this notice, beginning 6/14/2024 and ending 10/12/2024, regardless of when the payment or notice of denial of payment and disclosures were transmitted. Providers, facilities, and providers of air ambulance services may take advantage of this exception period by attesting that their ability to initiate open negotiation timely for an item or service was impacted by the effects of the cybersecurity incident. The Departments have published an attestation [ https://www.cms.gov/files/document/federal-idr-change-healthcare-cybersecurity-incident-attestation.pdf ] that providers, facilities, and providers of air ambulance services must furnish to plans or issuers alongside the standard open negotiation initiation form, and that providers, facilities, and providers of air ambulance services initiating the federal IDR process must furnish to non-initiating plans and issuers and certified IDR entities alongside the standard IDR initiation form, in order to invoke this exception period. Parties seeking to invoke this exception do not need to request extensions individually via the Federal IDR Inbox, as outlined in FAQs Pt. 55 [ https://www.cms.gov/files/document/faqs-part-55.pdf ].

IDR entities will be responsible for adjudicating, as part of their eligibility determination, any disagreement as to whether the initiating party is eligible to initiate open negotiation during this 120-day exception period. Non-initiating parties who believe disputes should not be eligible for this exception should provide documentation to support that assertion to initiating parties through open negotiation, as well as to certified IDR entities via the certified IDR entity selection process (see section 5.5 of Federal Independent Dispute Resolution (IDR) Process Guidance for Disputing Parties [ https://www.cms.gov/files/document/federal-independent-dispute-resolution-guidance-disputing-parties.pdf ]). The Departments will continue to monitor the progress toward the restoration of normal clearinghouse operations and will timely reevaluate whether it is necessary to provide additional time beyond the 120-calendar-day exception period, providing additional guidance as appropriate.

Questions can be directed to the Federal IDR Questions mailbox at FederalIDRQuestions@cms.hhs.gov.

The Federal IDR Team

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[1] [ #_ftnref2 ] "See" 26 CFR 54.9816-6T(d)(1) or (2), 26 CFR 54.9816-6(d)(1), 29 CFR 2590.716-6(d)(1) or (2), and 45 CFR 149.140(d)(1) or (2)

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Center for Consumer Information and Insurance Oversight (CCIIO)
Department of Health and Human Services
Centers for Medicare & Medicaid Services



Center for Consumer Information & Insurance Oversight




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