Overview
- The Department of Health and Human Services, Labor Department and Treasury told IPRO and Network Medical Review on Nov. 4 that their recertification petitions were denied for failing to meet minimum performance standards.
- Because of the denials, both entities are barred from accepting new independent dispute resolution (IDR) cases under the No Surprises Act and have 30 business days from the written notice to file an appeal.
- The agencies said guidance will be issued for parties with open disputes handled by those entities, leaving health plans and providers waiting for instructions on where ongoing cases will be transferred or reopened.
- Investigative reporting and stakeholder pressure from payer and employer groups flagged patterns of high arbitrator awards and financial incentives for some firms, including examples where arbitration outcomes produced payments far above in‑network rates.
- The decision is part of a larger five‑year recertification review: 14 IDR entities remain certified, eight petitions are under review, and regulators signaled more enforcement decisions or policy changes could follow.