CO| The Amended Regulation 4-2-65, which establishes a carrier payment arbitration program for out-of-network providers, effective March 30, 2025, details the process for out-of-network providers to request arbitration if they believe the payment received from a carrier was insufficient based on the complexity and circumstances of the services provided. The regulation covers the arbitration process, timelines, arbitrator qualifications, and the responsibilities of all parties involved.
Key points:
- Out-of-network providers can request arbitration within 90 calendar days of receiving payment if they believe it was insufficient.
- The arbitration process includes options for informal settlement teleconferences and strict timelines for appointing arbitrators and making decisions.
- Arbitrators must meet specific qualifications, including training, experience in healthcare billing, and absence of conflicts of interest with carriers, healthcare facilities, or providers.