Following passage of the No Surprises Act in December 2020, IPRO became one of the first Independent Dispute Resolution Entities (IDRE) as certified by the U.S. Department of Health and Human Services, the Department of Labor, and the Department of Treasury. As an independent, non-profit organization, IPRO offers fair, impartial, and swift payment dispute resolution between providers and health plans for certain out-of-network services rendered to health plan enrollees.

Since the IDR program’s inception, IPRO has maintained a record of providing excellent customer service and meeting the needs of both providers and health plans with an emphasis on quality and integrity.

Our Expertise

IPRO has nearly 40 years of experience as a federal and state contractor providing a range of services related to the evaluation and improvement of healthcare quality. IPRO is an Independent Review Organization (IRO) in 16 states and the District of Columbia and has served as an IDR for New York State since 2016. IPRO was one of the first organizations to be accredited by URAC to conduct external, independent reviews of managed care coverage disputes.

Our Team

With its corporate headquarters in Jericho, New York, and offices in Albany, New York, Hamilton, New Jersey, and Beachwood, Ohio, IPRO employs more than 350 healthcare professionals including:

• Physicians
• Registered Nurses
• Mental Health Professionals
• Medical Record Reviewers
• Pharmacists
• Coding Professionals
• Claims Analysts
• Auditors
• Data and Analytics Professionals

IPRO also retains a network of more than 300 board-certified physician consultants.

How to Initiate a Claim with IPRO

If a provider and a health plan are unable to agree on the payment amount for an out-of-network service covered by No Surprises rules, they may select IPRO to make a payment determination. Both parties (the provider and the health plan) must agree upon the entity selected to perform the IDR.

Once the claim has been received and is determined to be eligible for IDR services, IPRO will contact both provider and the health plan to request specific documentation related to the services provided, fees charged, amount of reimbursement, etc.

For Additional Information

For specific questions regarding IPRO’s IDR program, or to inquire about a dispute, please contact idr@ipro.org.

To learn more about the No Surprises rules, visit the Centers for Medicaid & Medicare website.