In March, The Centers for Medicare & Medicaid Services (CMS) announced that later this year the Federal Independent Dispute Resolution (IDR) process will transition to the new Federal “IDR Gateway.” The IDR Gateway is the portal discussed in the Proposed Operations Rule, and it will play a significant role in the future of the Federal IDR program.
While payers, providers, and entities like FHAS await the final proposed rule, currently in the final leg of its review at the Office of Budget and Management (OMB), CMS has made it clear that the portal is coming.
According to CMS, the IDR Gateway will “provide a secure, centralized platform that parties can use to manage disputes” and will replace the current single-use web forms.
Faulty or incomplete communications and information exchanges between the parties, along with timeliness issues, cause a significant number of cases to be ruled ineligible for the Federal IDR process. But tasks expected to be required within the new Gateway – and other new requirements of the proposed rule – are intended to solve these issues.
What Providers Need to Know About the New Federal IDR Gateway
According to CMS, IDR Gateway users will be able to:
- Start and respond to disputes.
- Access dispute dashboards and reports associated with their organization.
- Track dispute information, including disputes assigned to a certified IDR entity.
- Monitor assigned disputes by process phase.
- Review notifications regarding dispute activity.
As noted in an earlier post, the new portal or IDR Gateway should help foster better communications and information exchange, improve open negotiation, and circumvent ineligible claims from entering the process.
As CMS notes: “These proposed changes would create more certainty regarding whether and when an open negotiation period occurred by ensuring that start and end dates are documented in the Federal IDR portal. Additionally, these proposed changes may reduce the number of ineligible disputes initiated by requiring the exchange of eligibility information through the open negotiation notice and the open negotiation response notice.”
CMS also advises that the IDR Gateway will include new security features, including identity verification processes and protocols that permit only US-based users to access the Federal IDR process.
FHAS is a leading IDR Entity and exclusively holds the URAC IDR designation. We proudly set the quality benchmark and meet the highest industry standards for fair, transparent dispute resolution under the No Surprises Act.
We are regularly reporting on the proposed rule as it moves to finalization and will provide more information about the IDR Gateway as it becomes available.
We welcome parties to talk with us now to review their IDR program and prepare for the coming regulatory changes and requirements. Visit our online resources or contact us to set up a consultation.
Legal Disclaimer
The information contained in this content piece is for general informational purposes only. While we strive to ensure the accuracy and completeness of the information presented, we make no representations or warranties of any kind, express or implied, about the accuracy, reliability, suitability, or availability with respect to the content or the information, products, services, or related graphics contained in the content piece for any purpose. Any reliance you place on such information is therefore strictly at your own risk. The content of this page is subject to change without notice. The information provided in this document does not constitute legal or other professional advice, and is non-binding upon FHAS and any federal government agencies.
