Federal Independent Dispute Resolution (IDR)
The Federal Independent Dispute Resolution (IDR) process determines a payment amount for out-of-network items and services when job-based health plans/issuers and providers cannot agree.
HHS Fact Sheet
Get more information on the Federal IDR final rule.
HHS Fact Sheet
Get more information on the Federal IDR proposed rule.
Affordable Care Act Implementation FAQs Part 63
Read about how court decisions in 2023 affected batched disputes in the Federal IDR process.
Federal Independent Dispute Resolution (IDR) Process Administrative Fee FAQs
Learn more about how the 2023 court order affected the IDR administrative fee amount.
Independent Dispute Resolution (IDR) Partial Reopening of Dispute Initiation FAQs
These FAQs explain the reopening of the Federal IDR portal for the initiation of new single disputes after a temporary suspension due to the 2023 court orders.
Requirements Related to Surprise Billing, Part II
Fact Sheet
Learn about the August 2022 final rule.
CMS External Review Guidance Regarding State Process
Guidance for States, Plans, Issuers on Process Regarding Requirements in the No Surprises Act.
Requirements Related to Surprise Billing, Part I
This rule implements provisions of the No Surprises Act and restricts 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.
Affordable Care Act Implementation FAQs Part 73
This FAQ addresses the implementation of the No Surprises Act.
Affordable Care Act Implementation FAQs Part 71
This set of FAQs addresses the No Surprises Act and limitations on cost sharing under the Affordable Care Act.
Model Notice
View disclosure requirements for plans beginning on or after January 1, 2022.
HHS Guidance on Model Notice
View disclosure guidelines for health insurers and carriers.
Fact Sheet for Group Health Plans and Health Insurance Issuers
Read more about the July 2021 interim final rule.
Affordable Care Act Implementation FAQs Part 67
These FAQs address implementation of the No Surprises Act.
Affordable Care Act Implementation FAQs Part 60
These FAQs address the No Surprises Act, limitations on cost sharing under the Affordable Care Act and transparency in coverage with regard to facility fees.
Affordable Care Act Implementation FAQs Part 55
These FAQs address implementation of the No Surprises Act and the Transparency in Coverage rules.
NOTE: Some of the guidance in FAQs Part 55 is affected by the decision in Texas Medical Association, et al. v. U.S. Department of Health and Human Services, et al., Case No. 6:22-cv-450-JDK (TMA III). See FAQs Part 62 for guidance on the relevant provisions in light of this court decision.
Affordable Care Act Implementation FAQs Part 49
These FAQs address implementation of the No Surprises Act.
Requirements Related to Air Ambulance Services, Agent and Broker Disclosures, and Provider Enforcement
Air ambulance providers, insurance companies, and health plans must provide certain information to the Federal Government.
Air Ambulance Data Collection
Get more details on the information you must submit.
Affordable Care Act Implementation FAQs Part 62
These FAQs address implementation of the No Surprises Act.
NOTE: Some of the guidance in FAQs Part 62 has been superseded by guidance contained in FAQ Part 67.
Provider Nondiscrimination
Listening Session Regarding Provider Nondiscrimination Under Section 2706a of the PHS act
Guidance for States, Plans, Issuers on Process Regarding Requirements in the No Surprises Act.
Listening Session Announcement Regarding Provider Nondiscrimination Under Section 2706a of the PHS act
Group Health Plan Service Provider Disclosure Under ERISA Section 408(b)(2)(B)
Temporary Enforcement Policy Regarding Group Health Plan Service Provider Disclosures Under ERISA Section 408(b)(2)(B)
December 30, 2021
This memorandum announces the Department of Labor’s (Department) temporary enforcement policy for group health plan service provider disclosures under ERISA section 408(b)(2)(B).