NASS Insider

May 03, 2022

CMS Opens Independent Dispute Resolution (IDR) Portal

The Centers for Medicare and Medicaid Services (CMS) recently announced opening of the Independent Dispute Resolution (IDR) portal, which allows providers, facilities, health plans, and issuers to resolve payment disputes for certain out-of-network charges to initiate the IDR process under the No Surprises Act. At the end of a 30-business day open negotiation period during which all parties work in good faith to try to reach an out-of-network payment agreement, the IDR process can be initiated.

For those claims for which the open negotiations period expired prior to the portal opening, providers have until May 6 to initiate the IDR process. For claims currently in the open negotiations period, the standard timelines will apply (ie, the IDR process must be initiated within 4 business days of the open negotiations period ending). The IDR portal can be accessed here.

Additional information and resources:
  • CMS resources on the No Surprises Act are available here.
  • CMS webinar to walk stakeholders through the IDR process.
  • Chart for Determining the Applicability for the Federal Independent Dispute Resolution (IDR) Process, which provides a high-level summary to assist in determining whether the Federal IDR process or a state law or All-Payer Model Agreement applies for determining out-of-network rates.
  • Revised Certified IDR Entities Guidance and revised IDR Disputing Parties Guidance, which provide updates to conform with the recent Texas Medical Ass’n, et al. v United States Department of Health and Human Services, et al. decision and provide further direction to certified IDR entities and disputing parties about the Federal IDR process.
  • The AMA recently released a toolkit outlining the payment process.
  • Additional AMA resources, letters, and litigation updates on the No Surprises Act available here.