No Surprises Act
Independent
Dispute Resolution
The federal IDR process resolves out-of-network payment disputes. It demands an entity independent of both sides that can document exactly how it reached a number.
Where FOCUS stands
FOCUS is expanding into Independent Dispute Resolution under the No Surprises Act. The capability rests on the same foundation as the review business: independence that can be documented, clinical judgment from board-certified physicians, and a case system that produces a defensible record of every determination.
What the process demands
Independence from both parties
An IDR entity must have no financial relationship with either the plan or the provider in a dispute, and must be able to demonstrate that on demand. FOCUS applies the same conflict screening it uses for external review.
A determination that survives scrutiny
Baseball-style arbitration produces one winner and one loser on every case, and the losing party reads the reasoning closely. The Review Management System records the offers considered, the information reviewed, the factors weighed and the basis for the selection.
Volume without drift
IDR caseloads arrive unevenly. Capacity that scales without changing how determinations are made is a platform question rather than a staffing question, which is why FOCUS built the system it runs on.
Adjacent expansion
The FOCUS roadmap also includes workers' compensation review, drawing on the same panel and the same determination discipline.
Ready to review the FOCUS way?
Tell us your specialty mix, turnaround requirement and level of review, and we will tell you plainly whether FOCUS is the right panel for it.
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