Higher fees and an extended reporting deadline are among the updated No Surprises Act (NSA) guidance and relief released by the Departments of Labor, Health and Human Services, and Treasury (the “Tri-Agencies”) on December 23. Specific updates include:

  • An increase to the federal Independent Resolution (IDR) Process administration fee, from $50 to $350 per party for disputes initiated after January 1, 2023. (Even the party that does not initiate the dispute must pay the fee.)
  • In October, the Tri-Agencies also allowed IDR entities (the firms performing the reviews) to increase their fees by 40%.
  • An extension to the deadline for self-funded plans to submit Consolidated Appropriations Act (CAA) RxDC Reporting requirements (health care and prescription drug data) from December 27 to January 31, 2023. (Note: MedBen filed for its self-funded clients on December 22, 2022 – five days before the original deadline.)
  • Penalty relief for errors and omissions in submitted CAA RxDC Reports to self-funded plans that make a good faith effort to submit the required data.

The Tri-Agencies also reported that from April to September 2022, over 90,000 surprise billing disputes were initiated through the federal IDR portal. About 4% of those (3,776) have reached a payment determination, while roughly 18% (15,895) of the disputes were found ineligible for the Federal IDR process.

As of December 31, MedBen has received 15 surprise billing disputes, with five found ineligible for the process and five pending initial review. Two fees have been paid by clients so far.

As always, if you have any questions about self-funded plan requirements under the NSA, do not hesitate to contact Caroline Fraker or Erin Kelly in the MedBen Compliance Department.