CMS opens sign-ups for surprise medical billing dispute portal

Health care providers and payers will soon manage disputes involving surprise out-of-network medical bills through a centralized platform from the Centers for Medicare and Medicaid Services, replacing legacy single-use web forms.

Through the IDR Gateway platform, users will be able to start and respond to the federal independent dispute resolution, or IDR. They will also be able to access information through dashboards and reports and monitor dispute updates throughout the IDR process, according to CMS. 

The No Surprises Act created the IDR process to settle out-of-network payment disagreements between providers and payers, protecting patients from negotiations and surprise medical bills.

The IDR Gateway platform was first announced in March, but sign-ups did not start until Sept. 15. Importantly, it has not yet fully replaced the legacy IDR process.

Starting on Nov. 13, users will be able to submit important forms — a Notice of IDR Initiation, Notice of IDR Initiation Response, Notice of Certified IDR Entity Selection, and Notice of Offer — through the CMS platform. All IDR web forms, except for the Notice of IDR Initiation – Resubmission, will no longer be available outside of the IDR Gateway platform on Jan. 15, so users will have to create online accounts to navigate the IDR process.

Users must digitally identify themselves using Login.gov, ID.me, a federal personal identity verification card or credentials from CMS’ Enterprise User Administration or Identity Management system to create an account. In addition to providers and payers, designated third-party representatives, CMS-certified dispute arbitrators and other parties involved in the IDR process can create an account to navigate disputes.

The portal’s initial release will not include application programming interface access to dispute data or features supporting the 30-business-day open negotiation period before the IDR process can be initiated, according to a CMS technical guidance document. 

The IDR Gateway platform could address the inadequacies facing legacy single-use web forms.

The federal government estimated that only about 22,000 disputes would be initiated through the IDR process each year, but CMS has instead seen millions of cases. Between April 15, 2022, and Sept. 30, 2026, 7,798,616 disputes have been initiated and 7,304,875 have been closed, resulting in a backlog, according to CMS data. 

Moreover, under the current IDR process, single-use web forms trigger email notifications to providers, payers and CMS. The email traffic can make it difficult for parties to track a dispute’s status and stay on top of legal deadlines, Jeffrey Davis, senior policy advisor at Holland & Knight, told Nextgov/FCW.

The IDR Gateway platform is meant to “help clarify and keep everyone kind of on the same page of where we are in different parts of the process,” he said. 

But under the initial IDR Gateway implementation, parties will continue to receive email notifications and track dispute information in the portal, according to the technical guidance document.

Still, the American Hospital Association, a major hospital trade group, said in a statement to Nextgov/FCW that it “has supported the build out of the IDR Gateway platform to improve all parties’ ability to track a case and streamline action steps. In addition, the AHA expects the Gateway will help federal regulators with oversight of the program by capturing whether timelines and other requirements are being met.”

“Health plans support the goal of having a secure, centralized platform that can bring greater transparency to disputes within the IDR process,” Chris Bond, a spokesman for major payer trade association AHIP, also said in a statement to Nextgov/FCW.

“However, there are still significant changes that are needed to protect consumers and employers from the costly provider-led abuse of the arbitration process, including fixing the flawed incentives that drive unprecedented volume through IDR, greater oversight of IDREs, and guardrails on inflationary IDR awards,” he added.

AHIP has argued that the IDR process has cost Americans $22.4 billion in “wasteful spending” from 2022 to 2025 and has been abused by private equity-backed groups.

Lawmakers have sought to reform the IDR process, with Rep. Frank Pallone, D-N.J., going as far as to propose replacing arbitration with a new payment system.