Improper Use of the Federal Independent Dispute Resolution Process

EmblemHealth recently mailed a letter to certain providers regarding the appropriate use of the Federal Independent Dispute Resolution (IDR) process established under the No Surprises Act.

The Federal IDR process is intended to resolve payment disputes for certain qualifying covered services. Providers should review all applicable Federal requirements before initiating an IDR dispute.

For more information, including a copy of the provider letter and resources related to the Federal IDR process, see:

Provider Letter Regarding Appropriate Use of the Federal IDR Process (PDF)

Providers should refer to their explanation of payment (EOP) or remittance advice for claim determination information and applicable denial reasons.