Review & Appeals
Out-of-network providers can review the No Surprises Act (NSA) language related to initiating a federal Independent Dispute Resolution (IDR) request. An IDR request may be submitted following the unsuccessful conclusion of an Open Negotiation period in order to determine the out-of-network rate for certain qualified items or services.
Per the federal No Surprises Act (NSA), disputing parties must engage in a 30-business-day open negotiation period to attempt to reach an agreement regarding the total out-of-network rate for a qualified item or service. To initiate the open negotiation period, the initiating party must provide notice to the other party within 30 business days of the receipt of initial payment or notice of denial of payment for the item or service.
The Request for Claim Review form is the final page in the guide. The guide and form were created by the MassCollaborative.
