Biden Administration Gives Providers Grace Period To Open Surprise Billing Arbitration

The Biden administration is giving providers impacted by the cyberattack on payments processor Change Healthcare more time to request out-of-network billing arbitration under the No Surprises Act.

According to a government notice on Friday, providers have reported being unable to kick off that process, called independent dispute resolution, because necessary information from plans has been delayed following the attack, which threw a major wrench into the financial operations of hospitals and doctor’s offices earlier this year.

Under the No Surprises Act, providers can request an extension to initiate dispute resolution if plans don’t disclose required information along with reimbursement, or deny a payment, in a timely manner.

However, payment for a “very large volume of items and services was impacted” by Change, “making individual extension requests burdensome for disputing parties,” wrote the HHS and Labor and Treasury Departments, which oversee No Surprises, in the notice. The cyberattack has also made it difficult for providers to determine the date of plan payment and coverage denials, and match payments to delivered medical care, the notice says.

As a result, the departments are giving providers impacted by the attack 120 days after the publication of the notice — until October 12 — to initiate open negotiation for any services furnished this year.

That window could be extended if necessary, according to the notice.

Change, a subsidiary of healthcare behemoth UnitedHealth that handles billions of payments transactions each year, was hit by a cyberattack in February after hackers accessed the company’s network through a portal that lacked multifactor authentication.

Along with compromising the data of an estimated one-third of Americans, the attack also threw healthcare payments processing across the U.S. into disarray, creating a backlog of claims for providers and threatening the financial health of smaller practices without the resources to operate amid payment delays.

UnitedHealth, facing intense public criticism, regulatory scrutiny and a number of lawsuits from providers and consumers, offered a temporary loan program that was slammed by providers as being inadequate. Meanwhile, the government has attempted to take some pressure off providers through actions like tapping Change to notify consumers about the breach.

As a result, additional time to file independent dispute resolution, or IDR, requests is likely welcome for providers, alleviating the impacts of Change on a system that’s also been a major source of stress.

No Surprises was passed in 2021 to hold patients blameless for unexpected out-of-network medical bills. But the IDR process regulators set up to enact the law has been dogged with complaints from providers that argue it’s unfairly skewed in favor of health insurers.

As a result of lawsuits lodged by providers, the Biden administration has been forced to stop and rejig IDR multiple times since launching the process in 2022. Partially as a result of those pauses, IDR has been bogged down by a growing backlog of billing disputes.