HHS, the Labor Department and the Treasury Department are denying recertification for two independent dispute resolution entities — Island Peer Review Organization, known as IPRO, and Network Medical Review Company — according to a Nov. 4 update from CMS.
Under the No Surprises Act, IDR entities are intended to be impartial parties that resolve out-of-network payment disputes between payers and providers. These entities’ certifications are reviewed every five years. The other certified entities that are seeking recertification are still under review.
The CMS update said the two entities “failed to meet minimum performance standards.”
“The departments regularly monitor certified IDR entities’ performance to ensure compliance with program requirements and will continue to take appropriate action — including denial of recertification or revocation of certification — when an IDR entity fails to meet the standards necessary to administer the federal IDR process in accordance with the NSA and regulatory requirements,” the announcement said.
IPRO and Network Medical Review Company cannot accept new disputes under the federal IDR process. Health plans and providers in an open dispute with one of the entities should expect guidance on next steps. The entities can appeal within 30 business days of the departments’ written denial notice.
The denials come after pressure from payer and employer groups. Letters sent to federal officials in October called for more scrutiny of arbitrators.
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