The Department of Health and Human Services, the Department of Labor, and the Department of the Treasury have certified ProPeer Resources to serve as a certified Independent Dispute Resolution Entity (IDRE) in the Federal IDR process between out-of-network providers, facilities, or providers of air ambulance services and group health plans, health insurance issuers in the group and individual market, or Federal Employees Health Benefits (FEHB) Carriers.
If an out-of-network provider, facility, or provider of air ambulance services and a health plan, issuer, or FEHB Carrier can’t agree on the payment amount for an out-of-network item or service provided on or after January 1, 2022 that is covered by the No Surprises Act, as a certified IDRE, ProPeer Resources can be selected to determine the payment amount.
ProPeer Resources has served government entities since 1992 providing equitable and trusted services. For questions or concerns regarding administrative and IDRE Fee transactions related to a dispute assigned to ProPeer Resources, please contact idre@propeer.com.
For any questions regarding the No Surprises Act or for more information regarding any of its provisions, including the Federal IDR process, visit https://www.cms.gov/nosurprises.
With access to over 1,100 board certified specialties across the US, ProPeer can provide the independent expertise necessary to determine appropriateness of care, medical necessity, experimental/investigational related reviews. We specialize in ensuring quality reviews that meet the standards of accreditation, regulation, and client need.
The challenges faced by medical facilities, hospitals, and community health centers are unique and complex. ProPeer has developed a customized suite of services to address quality of care that aids in the prevention unintended outcomes and medical errors.
Ensuring quality of care and compliancy can be extremely cumbersome and time consuming. ProPeer offers customized solutions that fit perfectly into any quality assessment or audit program. Our team of medical experts help solve problems and deliver results.
Any inquiries related specifically to the Federal IDR process, or to initiate a dispute, should be directed to the official CMS IDR email: FederalIDRQuestions@cms.hhs.gov.
ProPeer Resources (IDREApp-110) can be validated as a certified IDRE at List of certified organizations | CMS.
ProPeer’s leadership looks forward to serving you by providing the fair and balanced decisions you deserve.
Elimination of potential conflicts of interest including professional, organizational, and/or personal bias inherent to review programs performed or supported with internal reviewers.
Removal of the administrative burden and strain on internal quality assurance/risk management programs by providing efficiency and mitigating the fixed staffing cost of these internal initiatives.
Providing access to a broad range of specialties in instances when facilities’ in-house expertise may be limited.
Objectively monitoring and measuring the quality of care delivered, allowing for benchmarking which can provide the foundation for staff coaching and training.
Providing a systematic and scalable approach ensuring review criteria and results are accurate, reliable which reduces risk by identifying trends and potential issues of clinical staff performance, deficiencies, and errors.
Providing timely, standardized reporting as well as ad-hoc reporting capability improving internal evaluation, review efficacy and streamlining any external reporting mandate to demonstrate compliance quality program performance.