Dispute Resolution
As of November 2022, iMPROve Health is a certified informal dispute resolution (IDR) entity. In addition, we provide Informal Dispute Resolution (IDR) and Independent Informal Dispute Resolution (IIDR) services to state agencies for providers who choose to dispute federal and/or state citations, known as “deficiencies,” following standard and complaint-based surveys. We conduct these reviews for skilled nursing facilities, intermediate care facilities for individuals with intellectual disabilities, home health agencies, and other state-licensed providers. These services often serve as alternatives to legal proceedings.
The Department of Health and Human Services, the Department of Labor, and the Department of the Treasury have certified iMPROve Health to serve as a certified independent dispute resolution (IDR) entity in the Federal IDR process between out-of-network providers, facilities, or providers of air ambulance services and group health plans, health insurance issuers in the group and individual market, or Federal Employees Health Benefits (FEHB) Carriers.
Informal Dispute Resolution and Independent Informal Dispute Resolution
iMPROve Health’s IDR/IIDR programs offer timely, objective, and independent reviews that apply standardized processes. Using a decision-making algorithm, our reviewers carefully assess cited deficiencies, materials provided by the facility to refute the citations, as well as regulations and current clinical practice standards. iMPROve Health is a respected third-party review option for state agencies and providers nationally. We are fully accredited by URAC.
We ensure that no IDR/IIDR review decisions are influenced by any individual(s) involved in issuing the deficiency statement or who provide services to the nursing facility in question.
Our IDR reviewers are RNs, or other health or life-safety code professionals, with broad knowledge of federal and state regulations and current clinical practice standards. Our reviewers have experience as surveyors and/or administrative healthcare providers. iMPROve Health provides reviews for several states.
Texas IDR
iMPROve Health contracts with the Texas Health and Human Services Commission to provide Informal Dispute Resolution (IDR) services for skilled nursing facilities, intermediate care facilities for individuals with intellectual disabilities, and assisted living facilities. We conduct IDR services to dispute citations resulting from the survey process.
Use the iMPROve Health IDR Portal to submit an IDR/IIDR case. Follow along with step-by-step instructions below for the portal, Frequently Asked Questions and other resources.
