Under the
No Surprises Act that was signed into law as part of the Consolidated Appropriations Act of 2021, out-of-network providers are offered an independent dispute resolution (IDR) process intended to help keep health care costs down.
If an out-of-network provider is unsatisfied with the payment received for services rendered, they can initiate a negotiation with insurers, like AmeriHealth HMO, Inc. (AmeriHealth). They can also initiate an IDR to help reach an agreement on payment for services rendered.
Submission timeline
Initiate 30-business-day open negotiation period (using the methods below)
| 30 business days, starting on the day of initial payment or notice of denial of payment |
| Initiate independent dispute resolution process following failed open negotiation (using the methods below) | 4 business days, starting the business day after the open negotiation period ends |
| Mutual agreement on certified independent dispute resolution entity selection | 3 business days after the independent dispute resolution initiation date |
| If parties cannot agree to an independent dispute resolution entity, the Departments will select one | 6 business days after the independent dispute resolution initiation date |
| Submit payment offers and additional information to certified independent dispute resolution entity | 10 business days after the date of certified independent dispute resolution entity selection |
| Payment determination made | 30 business days after the date of certified independent dispute resolution entity selection |
| Payment submitted to the applicable party | 30 business days after the payment determination
|
Submission process
To initiate a negotiation with AmeriHealth, you may submit a completed
Open Negotiation Notice issued by the Departments of Treasury, Labor, and Health and Human Services using the following methods:
Please include the claim number in the subject of the email to ensure timely processing.
AmeriHealth
Attn: Total Value Reimbursement and Contracting
1901 Market Street
Philadelphia, PA 19103
Please include the claim number on the form to ensure timely processing.
If negotiations end without an agreed-upon different total payment amount, you may initiate the IDR process by submitting a
Notice of IDR Initiation through the
IDR Portal and use the email above as the primary point of contact for AmeriHealth. Please provide a copy of your IDR request using the above methods.
More information
Review these recently updated
FAQs prepared jointly by the Departments of Labor, Health and Human Services (HHS), and the Treasury.
For more information on the Consolidated Appropriations Act of 2021 or the No Surprises Act, visit the
Pennsylvania Insurance Department website.