1
OMB Control No. 1210-0169
Expiration Date: 11/30/2025
Open Negotiation Notice
Instructions
The Departments of the Treasury, Labor, and Health and Human Services (Departments) and the
Office of Personnel Management (OPM) have issued interim final rules establishing a Federal
independent dispute resolution process (Federal IDR process) that nonparticipating providers or
facilities, nonparticipating providers of air ambulance services, and group health plans and health
insurance issuers in the group and individual market or Federal Employees Health Benefits
(FEHB) carriers may use following the end of an unsuccessful open negotiation period to
determine the out-of-network rate for certain services. More specifically, the Federal IDR
process may be used to determine the out-of-network rate for certain emergency services,
nonemergency items and services furnished by nonparticipating providers at participating health
care facilities, and for air ambulance services furnished by nonparticipating providers of air
ambulance services where an All-Payer Model Agreement or specified state law does not apply.
Before accessing the Federal IDR process to determine the out-of-network rate for a qualified
item or service, the disputing parties must engage in a 30-business-day open negotiation period
to attempt to reach an agreement regarding the total out-of-network rate (including any cost
sharing). To initiate the open negotiation period, the initiating party must provide notice to the
other party within 30 business days of the receipt of initial payment or notice of denial of
payment for the item or service. The open negotiation period begins on the day that the initiating
party sends the open negotiation notice. Specifically, the initiating party may initiate the open
negotiation period by sending an open negotiation notice to the other party by mail. The
initiating party may also send the notice electronically if the following two conditions are
satisfied: (1) the initiating party has a good faith belief that the electronic method is readily
accessible by the other party; and (2) the notice is provided in paper form free of charge upon
request.
The Departments have developed this open negotiation notice that plans, issuers, FEHB carriers,
providers, facilities, or providers of air ambulance services must use to initiate the open
negotiation period. To use this open negotiation notice properly, the plan, issuer, FEHB carrier,
provider, facility, or provider of air ambulance services must fill in the blanks with the
appropriate information. The party initiating open negotiation should use 1 Open Negotiation
Notice per each out-of-network item or service, unless a plan, issuer, or FEHB carrier made an
initial payment as a bundled payment (or specifies that a denial of payment is made on a bundled
payment basis) or the initiating party intends to batch all the items or services included in the
notice, as permitted under the interim final rules as part of the Federal IDR process.
1
1
For additional information about disputes for bundled and batched items and services, including definitions, see
Federal Independent Dispute Resolution (IDR) Process Guidance for Disputing Parties, available at
https://www.cms.gov/sites/default/files/2022-04/Revised-IDR-Process-Guidance-Disputing-Parties.pdf.