Surprise bill disputes

Important information regarding No Surprises Act open negotiation and Independent Dispute Resolution (IDR)

Providers and facilities may be eligible to request an open negotiation period under the No Surprises Act. To learn more about the open negotiation process, payment amounts or to request a 30-business-day open negotiation period, you can:

Providers and facilities may also be eligible to use the IDR process following the open negotiation period, subject to eligibility requirements and deadlines. Responsibility for payments resulting from the IDR process remains with the group health plan.

If the payment amount remains unresolved, you may initiate the independent dispute resolution process within 4 days after the end of the negotiation period at IDR@clearhs.com.

Note: For outpatient facility claims priced at the claim level (for example, bundled claims), each service code’s qualified payment amount (QPA) represents a proportional share of the total claim QPA. This information may be helpful when reviewing claim repricing and payment determinations.