IPRO has been designated as a certified Independent Dispute Resolution entity (IDRE) by the U.S. Department of Health and Human Services, the Department of Labor, and the Department of Treasury. This designation indicates that, as part of the No Surprises Act, IPRO may perform payment dispute resolution between providers or facilities and health plans for certain out-of-network services received by health plan enrollees.
Our Expertise
IPRO has nearly 40 years of experience as a federal and state contractor providing a range of services related to the evaluation and remediation of healthcare quality. IPRO is an External Quality Review Organization (EQRO) in 11 states and Puerto Rico and an Independent Review Organization (IRO) with contracts in 15 states and the District of Columbia.
IPRO has served as an IDR for multiple states, including New York, since 2016.
Our Team
With its corporate headquarters in Lake Success, New York, and offices in Albany, New York; Morrisville, North Carolina; and Beachwood, Ohio, IPRO employs more than 350 healthcare professionals including:
- Physicians
- Registered Nurses,
- Mental Health Professionals
- Medical Record Reviewers
- Pharmacists
- Coding Professionals
- Claims Analysts
- Auditors
IPRO also retains a network of more than 300 board-certified physician consultants.
You can reach us via email at idr@ipro.org.
About the IDR Process
Starting January 1, 2022, if a provider or facility and a health plan can’t agree on the payment amount for an out-of-network service covered by No Surprises rules, they may select IPRO to make a payment determination. Both parties (the provider or facility and the health plan) must agree upon the entity selected to perform the IDR.
Once the process begins, IPRO will contact both the facility or provider and the health plan to request specific documentation related to the services provided, fees charged, amount of reimbursement, etc.
For Additional Information
For specific questions regarding IPRO IDR or to inquire about a dispute, please contact idr@ipro.org.
To learn more about the No Surprises rules, visit the Centers for Medicaid & Medicare website.
