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IDR Common Objections Series - Part 2

Review of the most frequent objections seen by IDREs  

This is the second in a series of articles that will review the most common objections, errors, and issues seen in the Independent Dispute Resolution process.  Missed the first installment of the series? You can find it here:

This article outlines the common objection—no claim information and unidentifiable claim—and provides the correct process to avoid or address them: 

No Claim Information

  • The non-initiating party never received an initiation form. 

Unidentifiable Claim 

  • The non-initiating party receives an initiation that cannot be matched to a patient in their internal systems (e.g. numbers are transposed, or the payor receiving the initiation is not responsible for the claim). 

How to Address Objections 

To ensure compliance with CMS guidelines and avoid potential objections, follow these steps:  

  1. Confirm that the payor named on the Explanation of Benefits submitted by the payor is correctly reflected in the Notice of IDR Initiation. 
  2. Confirm that the claim number is correct before submitting the initiation notice.  
  3. Confirm that the correct telephone number and email address of the service provider are included.  
  4. If requested by an entity, provide an explanation of benefits that clearly identifies the responsible plan or issuer as well as the claim number. 

Note:

  • The provider can request an extension on the grounds that all necessary information was not provided.  
  • If these errors are made at initiation, the entity can fix them and move forward with the dispute. However, if this information was transposed since open negotiation, then the dispute will be considered ineligible.   

For a full explanation of these steps, refer to the CMS guidelines.  

Conclusion 

Ensuring that all submitted information is accurate is key to a successful IDR submission. Simple errors early on can cause a dispute to be determined ineligible.