New IDR portal sign-ups open for No Surprises Act disputes

Payers and providers can now create accounts for the new portal for the federal independent dispute resolution process under the No Surprises Act.

The CMS announced on Wednesday that account creation for the IDR Gateway is currently open. Any party that participates in the federal IDR process can create an account, sign in to the portal and join an organization, the agency states on its website.

This is the first step the CMS has taken to open the portal since it announced the centralized platform for managing out-of-network payment disputes in March. The agency designed the IDR Gateway to move away from single-use web forms to a secure, centralized place.

The federal IDR process has been wrought with complications since it launched in April 2022. Payers and providers have complained of a backlog of disputes amid swelling volumes, including a swarth of ineligible out-of-network claims.

The IDR Gateway aims to address chief complaints by providing a space to weed out ineligible claims through formal documentation, including new standardized remittance codes that indicate claim eligibility, and document open negotiations between payers and providers before the formal IDR process starts.

The law requires parties to engage in open negotiations 30 days before submitting a claim to the federal IDR process, but many have said these negotiations have gotten lost as parties navigate already-strained relationships and communication channels between payers and providers.

Through the portal, payers and providers will be able to formally initiate and respond to disputes, access dashboards and reports related to their organization and track dispute information, including cases assigned to specific IDR arbiters.

The portal will also monitor assigned disputes throughout the process and provide notifications on dispute activity, the CMS said.

Any individual or organization that processes disputes, represents parties or submits IDR web forms will need to sign up on the IDR Gateway to participate in the federal process in the future. That means payers and providers using a third party to manage disputes do not need to sign up, but they will need to ensure the outside organization has done so.

Third-party organizations, often backed by private equity, make up the bulk of federal IDR disputes. These organizations, including HaloMD, TeamHealth, Radiology Partners and SCP Health, have come under scrutiny over allegations they game the process for profit, scoring exorbitant payouts for provider clients.

Payers have generally supported the IDR Gateway, lauding its automatic ineligibility screening and pre-arbitration resolution. Payer groups have also praised geo-blocking protections, including restrictions on users outside the U.S., which they say will curtail the outsourcing of automated dispute generation to international billing farms.

However, they argue that the new portal is a band-aid on a failing system. The IDR process will continue to drive up premium costs, especially as approved arbiters continue to overwhelmingly favor providers.

A recent analysis from Georgetown University found that the process has generated over $22 billion in extra costs, including more than $15 billion in payouts that exceeded comparable out-of-network rates.

This has given out-of-network doctors a leg up in contract negotiations, leading to higher costs, they argue.

Still, the complete operational transition to the new portal is slated for late 2026. The CMS said that web forms will not be available outside of the IDR Gateway after Jan. 15.

Jacqueline LaPointe is an Executive Editor at Xtelligent Healthcare Media, covering revenue cycle management, healthcare payers, health policy and health IT since 2016.