HaloMD Meets with U.S. Office of Management and Budget Ahead of the Release of the IDR Operations Final Rule

Last week, HaloMD spoke with the Office of Management and Budget (OMB) and federal agencies that are actively reviewing the Independent Dispute Resolution (IDR) Operations final rule before its release.

The IDR Operations rule was initially proposed in October 2023 and, when finalized, would make operational and technical improvements to the federal IDR process under the No Surprises Act. HaloMD used this call as an opportunity to directly interface with OMB and federal agencies and highlight key issues with the IDR process that our clients are experiencing.

Key Policy Priorities Highlighted by HaloMD

During the discussion, HaloMD emphasized several major policy priorities:

1. Use of Claim Adjustment Reason Codes (CARCs) and Remittance Advice Remark Codes (RARCs)

In the IDR proposed rule, the Departments of Health and Human Services, Labor, and Treasury (the Departments) proposed requiring health plans to use No Surprises Act–specific RARCs and CARCs when providing the initial payment or notice of denial. The goal is to clarify state or federal eligibility for out-of-network dispute resolution.

HaloMD supports this proposal. However, during the call, we encouraged OMB and federal agencies not to delay the effective date of this requirement in the final rule. Health plans already have access to these RARCs and CARCs and should therefore be required to use them immediately upon publication of the final rule.

2. Use of an IDR Registry

The Departments also proposed requiring health plans subject to the Federal IDR process to submit certain information — including plan type — through a registry. These plans would then receive an IDR registration number that they would be required to disclose to providers at the time of initial payment or notice of denial.

HaloMD supports this proposal because it would simplify IDR eligibility determinations. Health plans are the only entities with all the necessary information — including plan type — to determine eligibility. Creating a registry would reduce administrative burden and help streamline the IDR process.

3. Shorter “Cooling Off” Period

Currently, once a certified IDR entity renders a payment decision, providers may not submit another IDR notice involving the same plan for a claim for the same or similar service for a 90-calendar-day “cooling off” period.

In the proposed rule, the Departments sought comments on alternative, shorter periods — including reducing the period to one business day for batched disputes. HaloMD expressed support for shortening the cooling off period to one business day not only for batched disputes, but for all disputes.

Due to delays in processing disputes, providers are experiencing situations in which claims are in a “perpetually cooling off” state because cooling-off periods are being stacked on top of one another. Additionally, certified IDR entities are applying the 90-day cooling off period differently, creating confusion about which claims are subject to the requirement.

Shortening the cooling off period to one business day would create greater clarity and consistency in how the requirement is applied. It would also allow all eligible claims to move through the IDR process without becoming stuck in a perpetual cooling off cycle.

 Commitment to Timely Finalization and Enforcement