ADR Notable Selected as Platform for “No Surprises Act” Dispute Resolution

Texas-based Yes Mediate has selected ADR Notable as its case management platform for out-of-network care reimbursement disputes between health care providers and insurance companies under the federal No Surprises Act.

The No Surprises Act dispute resolution process implemented in April 2022 protects patients covered by private health insurance plans from surprise medical bills. This occurs when a patient receives care from a provider outside their plan’s network and is billed for the difference between the provider’s charges and what their insurance covers.

To resolve such payment disputes, the Act established an arbitration process using certified independent dispute resolution entities, or IDREs. Learn how to become a certified IDRE here.  Yes Mediate has selected ADR Notable as its technology platform for the intake, tracking, and management of these disputes.

“ADR Notable is not only the perfect platform for our case management needs as arbitrators of ‘No Surprises Act’ disputes, but also offers the best support team I have ever worked with across any industry! Their tailored approach to customer satisfaction is unmatched.”

— Angela St. Julien, MDR, CPG, LTCO; CEO of Yes Mediate.

A recent Government Accountability Office (GAO) report found that nearly 490,000 No Surprises Act disputes were filed in the first 15 months of the program, far exceeding original estimates. Consequently, with such high demand, firms like Yes Mediate require robust tools to efficiently handle high volumes of disputes.  Adopting ADR Notable’s cloud-based platform gives the administrators tools to assign cases to the ten arbitrators, track the cases, and pay the practitioners.  The arbitrators, expected to double in number during 2024, get a set of customized technology tools to help resolve the disputes in an expeditious manner.

Features include:

Simple Case Initiation

The ADR Notable platform features a straightforward case intake.  Therefore, cases can be assigned to an arbitrator and contact details and billing specifics can be quickly entered.  ADR Notable worked with Yes Mediate to customize some of the security settings and terminology to make the workflow more efficient for the arbitrators.

Structured online case creation improves accuracy and completeness compared to manual intake methods. In addition, it accelerates opening disputes so determinations occur faster.

Process Tracking and Oversight

Once a dispute is initiated, ADR Notable centralizes all case details, documents, notes, and messaging in a unified case folder. Authorized users have access based on the role assigned them by the administrator.

The case dashboard provides instant visibility into pending cases and tasks. As a result, this aids workflow coordination and highlights areas needing attention to prevent delays.

Customizable Workflows

ADR Notable’s robust and flexible checklist feature allows the administrators to map required dispute resolution steps and configure the associated notifications and reminders.

The customized checklists support workflows that keep cases progressing smoothly.  With open task reminders appearing on the main dashboard, they alert arbitrators of upcoming action items.  In addition, if the arbitrators elect to use the “Request Documents” feature, they will also see notifications on their dashboards when disputants need prompting to provide requested documentation.

Tools for the Arbitrators

Arbitrators can use ADR Notable’s specialized tools for assessing cases and recording determinations:

• Patented Digital Noteboard. Here, they log notes, document reviews, and determinations
• Library. Yes Mediate can maintain a central repository for forms, documentation, and general No Surprises Act information that is available to all the arbitrators.
• Case Documents. At the end of a case, an arbitrator downloads a form from the Library, completes it, and saves it to the Case Documents.

Consequently, arbitrators can quickly render fair determinations while protecting sensitive information.

Security, Compliance, and Support

As a platform managing private health data, ADR Notable employs enterprise-grade security protections including access controls and audit .

With everything stored securely in the cloud, authorized users can access cases and tools from anywhere. This enables remote coordination and resolutions.

ADR Notable’s US-based customer support provides ongoing assistance to optimize use of the platform.

We Can Help

ADR Notable can help those managing disputes submitted under the No Surprises Act by removing some friction from the process.  A platform already customized for this function can go a long way toward addressing that backlog of cases. The easy case initiation, process oversight, configurable workflows, and robust arbitrator tools will help streamline the process.  If you are looking for a way to expedite the case administration, ADR Notable is a ready-to-go solution for No Surprises Act case management for reimbursement disputes between health care providers and insurance companies.

Strict security and compliance controls also give confidence for managing sensitive health information. With responsive onboarding, training, and support, Yes Mediate is positioned to effectively arbitrate and resolve claims stemming from the new legislation.

ADR Notable continues to expand its portfolio of dispute resolution clients in health care, municipal agencies, and other industries. The platform scales to serve solo practitioners and small individual practices up to national and statewide mediation programs.

To learn more about ADR Notable’s specialized case and practice management tools, please visit www.adrnotable.com  or support@adrnotable.com.