Independent Dispute Resolution
Chapter 143 of the New Hampshire laws of 2024 created new consumer protections against balance billing by out-of-network (OON) healthcare providers and established a new, state-level process called independent dispute resolution (IDR), which is managed by the New Hampshire Insurance Department (the Department).
This process is available to health care providers and facilities as an alternative to the federally administered IDR process that was established under the federal No Surprises Act. Providers and facilities can use the state process to settle disputes with health plans about the payment rates for OON items and services that are subject to the prohibition on balance billing patients.
The New Hampshire state process uses federally certified IDR entities to determine the OON payment, and the criteria for determining the appropriate payment amount are the same. However, the state process is different from the federal process in the following ways:
- There is no administrative fee.
- The process is faster.
- Each party pays half of the IDR entity’s fee, rather than the loser paying the full fee.
- If the health carrier loses the dispute, the health carrier’s obligation to pay an additional amount is strictly enforced by the New Hampshire Insurance Department.
Visit the Independent Dispute Resolution Portal
The State IDR Process
The Open Negotiation Period
When an OON provider or facility gets an initial payment and remittance notice from a health plan for certain services that the provider or facility wishes to dispute, the provider or facility must decide whether to pursue the state or the federal IDR process. If the state process is chosen, the provider or facility must start an open negotiation period that lasts 20 business days. This is done by sending a Notice of Open Negotiation to the health carrier within 30 business days of receiving the initial remittance notice from the carrier.
Within 10 business days of receiving the Notice of Open Negotiation from the provider or facility, the health carrier must send an Open Negotiation Response Notice to the provider or facility. At the end of the negotiation period, if the provider or facility and the health carrier have not agreed on a payment amount, the provider or facility can initiate the New Hampshire IDR process.
Initiation of the State IDR Process
This is done by sending a Notice of IDR Initiation to the health carrier and going to the Department’s New Hampshire IDR Portal and uploading the same Notice of IDR Initiation, together with the prior Notice of Open Negotiation and Open Negotiation Response Notice. It is important to note that this must be done within 4 business days of the expiration of the 20 business day open negotiation period.
Within 3 business days of the filing of the Notice of IDR Initiation, the health carrier must file a Notice of IDR Initiation Response with the provider or facility and with the Department through the New Hampshire IDR Portal.
Within 5 business days of the filing of the Notice of IDR Initiation, the Insurance Department will determine eligibility of the dispute for the state IDR process and notify the parties. If the case is eligible, the Department will notify the parties and name a default IDR entity to the case using a randomized selection method. If either party prefers another IDR entity, the parties will then have 3 business days to agree upon the selection of a New Hampshire certified IDR entity and notify the Insurance Department of their selection. The list of New Hampshire certified IDR entities and their fees can be found at the bottom of this page. If the parties cannot agree on the selection of an alternate IDR entity, the Insurance Department will appoint the default IDR entity and convey the case documentation to that entity.
The appointed IDR entity will submit a no conflict-of-interest attestation to the Department within 3 business days of being appointed. At this point, the case proceeds under the review of the IDR entity, and the parties will be expected to communicate directly with the IDR entity as directed by the entity.
Batching of items and services
Similar items and services meeting certain specified conditions may be batched and submitted and considered jointly as part of one payment determination. For more detail on allowable batching of items and services see, Ins 2706.13 Treatment of batched items and services. If a provider or facility has improperly batched a number of items or services, the IDR entity will notify the parties of this within 5 business days of appointment to the case, and the provider or facility will be given the opportunity to resubmit one or more Notices of IDR Initiation.
Submission of Offers and Payment of the IDR Entity Fee
Within 10 business days of the appointment of the IDR entity, each party must submit its offer to the IDR entity using the Notice of Offer form. At the same time, each party must pay half of the IDR entity’s fee. Any party that fails to pay its half of the IDR entity's fee will have a default judgment entered against that party.
Selection of an Out-of-Network Rate
Within 30 business days of the appointment of the IDR entity, the IDR entity will make its determination and provide a written decision to the parties and to the Department. The OON rate selected by the IDR entity will be the rate contained in the Notice of Offer of the winning party.
If any payment is owed by one party to the other, it must be made within 30 calendar days of the IDR entity’s notice of determination.
Jurisdictional Limitations
The state IDR process is only available to healthcare providers or facilities who are in dispute with a fully insured health plan that is based in New Hampshire. The state IDR process is not available to providers or facilities who are in dispute with self-funded health plans (such as those sponsored by many large employers) unless that plan has opted into the state process. If the self-funded health plan has not opted into the state IDR process, then the provider or facility wishing to dispute the payment amount for OON items and services should pursue the federal IDR process.
Over time, the Department will develop a registry of fully insured health plans and self-funded plans that have opted into the state process. The registry will be available on this site and is intended to aid providers and facilities in determining whether the state IDR process will be available for resolution of any particular payment dispute regarding OON items or services. Providers or facilities having trouble determining whether a health plan is fully insured or self-funded may call the Department’s Consumer Services Unit at this number: 603-271-2261
Forms & Other Resources
Healthcare providers or facilities wishing to pursue the state IDR process must use these forms:
Health carriers or opting in health plans who are party to a state IDR proceeding must use these forms:
Fully insured health plans must register with the Department using this form:
Self-funded plans wishing to opt into the state IDR process may use this form:
A concise depiction of the steps and timelines in the New Hampshire state IDR process may be found here:
A copy of the legislation creating the New Hampshire state IDR process may be found here:
A copy of the regulation (draft form) governing the New Hampshire state IDR process may be found here:
New Hampshire Certified Independent Dispute Resolution Entities
For fee schedules, please refer to the federal postings. Please be advised that both parties will be responsible for half of the entity’s fee.
- Federal Hearings and Appeals Services, Inc.
- Keystone Peer Review Organization, Inc.
- Maximus Federal Services, Inc.
- MCMC Services, LLC
- National Medical Reviews (DBA: National Medical Reviews, Inc.)
- Network Medical Review Company (DBA: Network Medical Review Company, Ltd.)
Healthcare providers or facilities with questions about the IDR process may email their questions to nosurprises@ins.nh.gov.