ust 2022 final rules as modified by the opinion and order in TMA II. The Departments issued two separate process guidance documents—one for certified IDR entities and another for disputing parties. The guidance documents are intended to provide “information on how the disputing parties should engage in open negotiation prior to the Federal IDR Process, initiate the Federal IDR Process, select a certified IDR entity, and meet the requirements of the Federal IDR Process.” All of this has made for a complex web of rules and guidance. The notice clarified that the guidance documents issued on March 17, 2023, govern payment determinations “made on or after February 6, 2023 for items and services furnished on or after October 25, 2022 for plan years (in the individual market, policy years) beginning on or after January 1, 2022 by an out-of-network provider subject to the Requirements Related to Surprise Billing; Part II, 86 FR 55980, and Requirements Related to Surprise Billing; Final Rule, 87 FR 52618.” Meanwhile, payment determinations made before February 6, 2023, for items and services furnished on or after October 25, 2022, for the same plan/policy years are subject to the guidance document issued on October 31, 2022, and those made before February 6, 2023, for care provided before October 25, 2022, for the same plan years are subject to the guidance document issued on October 7, 2022, and effective July 26, 2022. (See Table 1 below.)Table 1: Applicable Federal Independent Dispute Resolution (IDR) Process Guidance for Certified IDR Entities and Disputing PartiesPlan or Policy Year Beginning on or after 1/1/22IDR Payment Determination Made Before or After 2/6/23Items and Services Furnished Before or On/After 10/25/22Applicable RulesApplicable GuidanceBeforeAfterBeforeOn/After☑☑☑Interim Final Rules10/07/22 Guidance☑☑☑Final Rules Apply10/31/22 Guidance☑☑☑Final Rules ApplyMarch 2023 Guidance The guidance documents state that the QPA—the health plan’s median contracted rate fo