Alaska IDR Arbitration For Medical Revenue Recovery

The Alaska SBL

The Alaska State Surprise Billing Law (SBL) became effective on July 1, 2017, as outlined in 3 Alaska Admin. Code § 26.110(a). A key provision of this law requires carriers to maintain charge data on a geographic basis, update it periodically, and ensure that payments reflect geographic differences. Payments must be no less than the 80th percentile of such charge data.

In terms of bifurcation, the Centers for Medicare & Medicaid Services (CMS) has acknowledged:

Alaska does not have an applicable All-Payer Model Agreement to determine out-of-network rates.
Based on survey responses and communications with the Alaska Division of Insurance, CMS recognizes that 3 Alaska Admin. Code § 26.110(a) is a specified state law governing out-of-network rate determination. This applies to items and services provided by nonparticipating providers, nonparticipating emergency facilities, and nonparticipating air ambulance providers for individuals with insured group health plans or group/individual health insurance coverage in Alaska.
As a result, the federal independent dispute resolution (IDR) process under sections 2799A-1(c) and 2799A-2(b) of the Public Health Service Act and 45 CFR 149.510 and 149.520 does not apply to such cases in Alaska.

(CMS Letter to the Governor of Alaska, February 15, 2022)