Kirk Davis, Danielle Gordet, writing for Akerman:
In December of 2022, the Departments had increased the fee from $50 to $350, effective January 1, 2023, to address “the rising volume of disputes and additional expenditures associated with the Departments’ enhanced role in 2023 in conducting pre-eligibility reviews to address the backlog of disputes.” Thereafter, the Texas Medical Association (TMA) brought suit against the Departments arguing that the $350 administrative fee was prohibitive for providers with small-value claims. On August 3, 2023, the U.S. District Court for the Eastern District of Texas found in favor of TMA (See Opinion and Order).
In response to the court’s decision, the Departments announced on August 11, 2023, that the administrative fee amount for any disputes initiated on or after August 3, 2023, will be $50 per party per dispute. However, for disputes initiated on or after January 1, 2023 through August 2, 2023, where a party had “paid” the administrative fee to a certified IDR entity, the administrative fee remains $350 and refunds will not be issued.