IPRO has become one of the first organizations to be certified as an Independent Dispute Resolution (IDR) entity by the US Department of Health and Human Services (HHS), the Department of Labor (DOL), and the Department of the Treasury. This designation indicates that IPRO may perform payment dispute resolution between providers or facilities and health plans for certain out-of-network services received by health plan enrollees, effective January 1, 2022.
The Independent Dispute Resolution process is part of the No Surprises Act which was designed to restrict surprise billing for patients in job-based and individual health plans who get emergency care, non-emergency care from out-of-network providers at in-network facilities, and air ambulance services from out-of-network providers. Among the numerous rules contained within the Act is the provision of a mechanism to resolve issues related to payment for emergency services between facilities, providers, and health plans.
IPRO has nearly 40 years of experience as a federal and state contractor providing a range of services related to the evaluation and remediation of healthcare quality. IPRO is an External Quality Review Organization (EQRO) in 11 states and Puerto Rico and an Independent Review Organization (IRO) with contracts in 15 states and the District of Columbia. It employs more than 350 healthcare professionals with offices New York, Connecticut, Ohio, and North Carolina.
“We are pleased to be among the first to have been designated as a certified IDR entity,” said Harry Feder, MPA, Senior Vice President and Chief Operating Officer, IPRO. “We look forward to continuing to protect consumers and assist providers and plans to make appropriate decisions as we have for more than 35 years of working on behalf of federal and state government.”
Additional information on the No Surprises Act can be found on the Centers for Medicare & Medicaid website. Learn more about IPRO’s IDR services here. For additional information, please email Idr.email@example.com.