8-16-23 Update: TMA IV Ruling – How to Proceed

CMS had another meeting with the entities late yesterday afternoon to communicate the following information:

• CMS’ next intention is to open up the IDR portal to allow for submission of single and bundled disputes. This is still in progress at this time.
• CMS is working through the disputes that require an extension due to the portal outage. This is still in progress at this time.  

No other updates were given.

Reminder of Current CMS Guidelines Related to the TMA IV Ruling

Certified IDR entities will only be granted access to resume the federal IDR process for:

• Open single and bundled disputes from 2023 
• Open single and bundled disputes from 2022
• Open single and bundled disputes where admin fees have been collected from both parties and updated in the portal prior to 8/3 OR if the payment deadline has expired prior to 8/3 and at least one party has paid
• Open previously determined eligible batched disputes where admin fees have been collected from both parties and updated in the portal prior to 8/3 OR if the payment deadline has expired prior to 8/3 and one party has paid
• Withdrawn or settled disputes where admin fees have been collected
• Any open disputes where the payment deadline has expired, and admin fees are set to ‘No’ for both parties

*Disputes that do not fall under these categories will not be accessible to the IDR entities.

In summary, with all that has been released to the entities – the following services are available:

• Status Updates – FHAS will only be able to give status updates for cases that we have access to in CMS.
• Sending New Links – FHAS will not be able to trigger new or old links for batched disputes – but all single 2022 and 2023 cases are accessible at this time.  
• Determining Eligibility – FHAS will continue to accept additional documentation for all claim types that we request; however, we are unable to request your offer and payment for batched disputes at this time.
• Determinations – Determinations can be made on:
  • Open single and bundled disputes from 2023 
  • Open single and bundled disputes from 2022
  • Open single and bundled disputes where admin fees have been collected from both parties and updated in the portal prior to 8/3 OR if the payment deadline has expired prior to 8/3 and at least one party has paid
  • Open previously determined eligible batched disputes where admin fees have been collected from both parties and updated in the portal prior to 8/3 OR if the payment deadline has expired prior to 8/3 and one party has paid
• Closing Disputes for Ineligibility – FHAS can still close a dispute for ineligibility IF we have access to the dispute.
• Withdrawals and Settlements – FHAS will continue to withdraw and settle disputes IF we have access to the dispute.
• Requesting Payment and Offer – FHAS will be requesting payment and offer for single or bundled disputes that we determine to be eligible.

Other updates of note include:

• At this time, certified IDR entities will be restricted from editing closed disputes, however, the entity can view them.
• The Departments also granted disputes in the Notice of Offer phase of the federal IDR process a blanket five business day extension to submit Notice of Offer webforms. The IT team is working to update due dates in the federal IDR portal; no additional actions required by the IDREs at this time. 
• FHAS will not be accepting offers that are sent through email. CMS will notify parties when to submit their offers in the instance that the deadline fell within the portal outage. FHAS is not responsible for issuing links for due dates that landed on dates affected by the portal outage.
• See the Admin FAQ below, from CMS.

IDR-Admin-Fees-FAQs-081123-508_0

FHAS will continue to update you as we find out more information. If you need further guidance email us at idre@fhas.com or give us a call at (570)779-5122 and ask for our IDR department! Thank you.

*Disclaimer* All information that is provided in these updates are received directly from CMS – either communicated to us on the CMS portal, by email, or spoken to us in a scheduled meeting with all other entities present.