CMS PPDR

StrategyGen: Prime Contractor for the CMS No Surprises Act Patient Provider Dispute Resolution (PPDR) 

Supporting Fair, Transparent Resolution of Medical Billing Disputes Under the No Surprises Act

StrategyGen is proud to serve as the prime contractor supporting the Centers for Medicare & Medicaid Services (CMS) and the Center for Consumer Information and Insurance Oversight (CCIIO) Patient-Provider Dispute Resolution (PPDR) program.

Through this important consumer-protection program, StrategyGen and our partner IPRO support CMS in administering a fair, timely, secure, and transparent process for resolving eligible payment disputes between uninsured or self-pay patients and healthcare providers and facilities.

What Is Patient-Provider Dispute Resolution?

The No Surprises Act established important federal protections designed to improve transparency in healthcare costs and protect consumers from unexpected medical bills.

For uninsured or self-pay individuals, healthcare providers and facilities generally provide a Good Faith Estimate of expected charges before scheduled care.

When an eligible patient subsequently receives a bill that is at least $400 higher than the expected charges identified in the Good Faith Estimate, the patient may initiate the federal Patient-Provider Dispute Resolution process.

Through PPDR, an independent dispute resolution process evaluates the Good Faith Estimate, the billed charges, supporting documentation, and other relevant information to determine the appropriate amount the patient should pay.

StrategyGen's Role in PPDR

StrategyGen brings extensive federal healthcare program management, regulatory compliance, clinical review, data analytics, and quality-assurance experience to the PPDR program.

As prime contractor, StrategyGen provides the management infrastructure, regulatory expertise, operational controls, quality oversight, and reporting capabilities required to support an accurate, impartial, secure, and accountable dispute-resolution process.

Our work encompasses four principal areas:

Program Management

• StrategyGen provides overall contract leadership, CMS coordination, project management, subcontractor oversight, quality management, risk management, performance monitoring, and operational reporting.

Patient-Provider Dispute Resolution

• Our team supports the complete PPDR lifecycle, including intake, documentation review, conflict-of-interest screening, eligibility determination, settlement processing, payment determination, notifications, and dispute closure.

Clinical, Coding & Regulatory Review

• PPDR cases may require detailed evaluation of healthcare services, billing information, Good Faith Estimates, supporting clinical documentation, medical necessity, unforeseen circumstances, and applicable federal requirements.
• Our multidisciplinary team brings healthcare administration, clinical, coding, legal, regulatory, and program-integrity expertise to these reviews.

Data Collection, Analytics & Reporting

• StrategyGen supports structured data collection, quality validation, statistical analysis, performance reporting, trend identification, and program oversight to provide CMS with timely and actionable information about PPDR operations and outcomes.

Protecting Patients. Supporting Providers. Strengthening CMS Oversight.

• Effective PPDR operations require more than processing individual cases.
• They require a system that combines consumer protection, regulatory compliance, healthcare expertise, operational efficiency, data integrity, and exceptional customer service.

StrategyGen's approach is designed to:

Protect consumers

• Support fair implementation of federal protections for uninsured and self-pay patients.

Promote transparency

• Help patients and providers understand the PPDR process and applicable requirements.

Deliver defensible determinations

• Apply consistent processes, healthcare expertise, regulatory requirements, and rigorous quality controls.

Reduce administrative burden

• Use disciplined workflows, experienced personnel, and efficient program management to support timely case resolution.

Strengthen CMS oversight

• Provide reliable data, reporting, operational visibility, and performance information to support effective federal program management.

Why StrategyGen

Proven CMS Experience

• StrategyGen has supported CMS since 2011 across complex healthcare regulatory, compliance, quality, program-integrity, and oversight initiatives.

Regulatory & Compliance Expertise

• Our teams translate complex statutes, regulations, CMS guidance, and program requirements into practical and defensible operational processes.

Multidisciplinary Healthcare Expertise

• StrategyGen brings together healthcare executives, clinicians, coders, regulatory experts, analysts, attorneys, project managers, and data specialists.

Data-Driven Program Management

• Our approach combines structured program management, quality controls, analytics, workflow management, and performance reporting.

Demonstrated Federal Performance

• StrategyGen has established a record of Exceptional and Very Good contractor performance ratings across its federal prime contracts.

Advancing Consumer Protection in Federal Healthcare

StrategyGen is proud to support CMS in advancing the goals of the No Surprises Act and strengthening transparency, accountability, and fairness in healthcare billing.

Through the Patient-Provider Dispute Resolution program, we are helping CMS deliver a dispute-resolution process designed to protect patients, support healthcare providers, and strengthen confidence in federal consumer protections.