On December 27, 2024, the Departments of Health and Human Services (HHS), the Department of Labor (DOL), and the Department of the Treasury (Treasury) (collectively, Departments) made updates to the No Surprises Act (NSA) website, reflecting revised certified Independent Dispute Resolution (IDR) entity fees.
The 2025 IDR entity fees remain unchanged from the 2024 fees. The 2025 fees are effective for disputes initiated on or after January 1, 2025, and are as follows: administrative fee is $115.00 per party per dispute and the certified IDR entity fee ranges for single determinations are $200-$840 and for batched determinations the range is $268-$1,173.
In addition, the website includes information on the fee set by each certified IDR entity. As a reminder the independent dispute process is used when a health plan and health provider are not in agreement on reimbursement for medical services. The patient is taken out of the middle of this dispute in three instances emergency services, certain nonemergency items and services provided by out-of-network providers at in-network facilities; and air ambulance services provided by out-of-network providers. In these situations, the patient is charged the in-network rate.
The information contained in this Benefit Beat is not intended to be legal, accounting, or other professional advice, nor are these comments directed to specific situations. This information is provided as general guidance and may be affected by changes in law or regulation. This information is not intended to replace or substitute for accounting or other professional advice. You must consult your own attorney or tax advisor for assistance in specific situations. This information is provided as-is, with no warranties of any kind. CBIZ shall not be liable for any damages whatsoever in connection with its use and assumes no obligation to inform the reader of any changes in laws or other factors that could affect the information contained herein.