IDR 101: Eligibility Determination
A significant number of disputes are failing to make it through the IDR process. The reason is simple: regulations are complex. Navigating the rules and requirements can be troublesome for both providers and payers and often can lead to miscommunication and issues. As regulations begin to be interpreted differently than what is intended, delays and frustration start to rise. To find a solution, we first need to understand which disputes are getting stuck and why.
Why are disputes frequently deemed ineligible?
Reliant’s Guide to Understanding IDR
Reliant understands the frustration that comes with navigating the complex landscape of IDR regulations and are committed to educating all parties on the process and providing the tools and knowledge to navigate the IDR process.
Enhanced Claims System
Programmed to review treatment state and underwriting state in conjunction with state balance billing laws for determining jurisdiction of state or federal balance billing protections.
Payment Date Review
By assessing payment schedules, we can accurately identify potential discrepancies to prevent delays and ensure a smooth process.
Avoid Unbatching
By reviewing IDR disputes for multiple disputes associated with a single claim, Reliant ensures all related services are grouped according to regulation. Not only does this help speed up the process but also reduce the risk of error.
Claim Edits for Unbundling
We review claim edits for unbundling to ensure each service is billed appropriately, prevent overpayments, and remain within regulatory standards.
Communication Review
Reliant reviews communication with providers to determine if the open negotiation period occurred and was completed within the required timeframe. This step is essential to confirm that all parties conducted proper communication before proceeding to the IDR process.
Reliant aims to prevent going into IDR but if IDR becomes necessary, our expert team strives to alleviate the stress caused by the complexity associated with IDR while providing cost effective solutions powered by our ClaimSaveIQ engine. Trust Reliant to be your partner to guide you through regulations with ease and expertise.
Maximize Savings. Minimize Noise.
Get in touch with our team.