Federal Independent Dispute Resolution (IDR) Health Care Arbitration Virtual Training

Schedule

All times listed are Eastern Time (ET).

Wednesday, December 9, 2026Day 1: Foundations, Ethics, and Eligibility

10:00-10:15 AM

Welcome and Introductions

  • Welcome and introduction to your presenters
  • Overview of the Arbitration Training Program and what to expect over the next two days
  • Attendee Poll
10:15-11:00 AM

1. The No Surprises Act and Federal IDR Process Overview

Madeline Hatfield

  • Why Does the No Surprises Act exist and what all does it do?
    • Surprise Billing protections
    • In-network processing requirements
    • Qualifying Payment Amount (QPA)
  • Overview of the independent dispute resolution process
  • Overview of healthcare privacy requirements
11:00-11:45 AM

2. In-network v. Out-of-network, Provider Networking Overview

Sheldon Faulk

  • An overview of provider and payor contracting goals and objectives
  • Standard contract negotiation and rate setting metrics
  • In-network benefits v. in-network providers
  • How do payors pay claims pursuant to network agreements
  • Payor requirements under the NSA
  • QPA calculation
11:45 AM-12:15 PM

3. Overview of IDR Eligibility

Madeline Hatfield

  • Understanding Jurisdictional eligibility
  • Procedural eligibility and what it requires
12:15-12:45 PM

Lunch Break

12:45-1:45 PM

4. Understanding the Items/Services Under Dispute

Madeline Hatfield, Tricia Hatfield

  • Fundamentals of reading an Explanation of Benefits (EOB), Provider Remittance Advice (PRA), and Health Insurance Claim Form (HCFA) documents
  • Basics of claims and coding: How to understand what services are under dispute (i.e. modifiers and units)
1:45-1:55 PM

Break

1:55-3:05 PM

5. Group Exercise - Claims

Madeline Hatfield, Tricia Hatfield

  • Analysis and group discussion of claims examples based on a hypothetical file handed out
3:05-3:15 PM

Break

3:15-4:30 PM

6. Conflicts of Interest and Legal Ethics

Hailey Forcella, Karen Crump-Wilson

  • IDRE Conflict of Interest Requirements
  • Legal Ethics

Thursday, December 10, 2026Day 2: Arbitration: The QPA, Offer Evaluation, Determinations

10:00-11:00 AM

7. Legal Landscape in IDR

Hailey Forcella

  • Overview of the regulations applicable to the NSA
  • Important case decisions
  • What legal challenges are outstanding
  • Final Rules implementation
11:00-11:10 AM

Break

11:10 AM-12:25 PM

8. Arbitration – What Information Can Be Considered and What Does the Information Mean?

Madeline Hatfield, Hailey Forcella

  • The QPA
  • Non-air ambulance factors
  • Air ambulance Factors
  • Additional Information
  • Prohibited information
12:25-12:55 PM

Lunch Break

12:55-1:55 PM

9. Group Exercise on factors

Madeline Hatfield, Hailey Forcella

  • Analysis and group discussion of drafting a written determination based on a hypothetical set of offers and supporting information
1:55-2:40 PM

Overcoming Unconscious Bias in Decision-Making

Karen Crump-Wilson

  • What is unconscious bias?
  • What causes bias?
  • Best practices for deciding fairly in a paper-only, offer-selection process
2:40-3:10 PM

10. Weighing Additional Information & Written Payment Determinations

Madeline Hatfield, Hailey Forcella

  • Baseball style Arbitration, which offer prevails?
  • Assessing the credibility of information submitted
  • Weighing the information submitted by the parties
  • Fundamental requirements of the written payment determination
  • Best practices when writing a rational and things to avoid
3:10-3:20 PM

Break

3:20-4:20 PM

11. Group Exercise on Drafting a Payment Determination

Madeline Hatfield, Hailey Forcella

  • Analysis and group discussion of drafting a written determination based on a hypothetical set of offers and supporting information
4:20-4:30 PM

Final Remarks and Conclusion