Following our earlier post on CMS’s updates regarding IDR operations and the portal, CMS and the Departments of Labor and the Treasury have continued to release updates regarding implementation of the IDR operations rule and signals of NSA enforcement. Key developments:
- IDR Gateway updates go live November 13. Parties should confirm that they, or their TPA, have completed Gateway sign-up and identity verification. On November 13, 2026, the Federal IDR process fully transitions into the IDR Gateway, integrating existing web forms and introducing new dispute dashboards and reports. Only users who have joined an organization can access the dispute dashboards and reports linked to their organization to track the status of their disputes. CMS has published the Dispute Processing User Guide and the Administrator User Guide, with more information on the IDR Gateway page.
- The initial rollout does not include functions to support open negotiation, which will be required in the Gateway once those features are available. The IDR Registry is also not yet available, so plans and issuers are not yet required to register. They will have 90 business days to do so after the Tri-departments announce that the functionality is available.
- Batching and bundling guidance. On October 29, 2026, the Departments released guidance on the treatment of batched and bundled qualified IDR items and services under the Federal IDR Operations Final Rule. The new rules apply to batched disputes with open negotiation periods beginning on or after November 1, 2026.
- Batches are limited to 50 line items. Service code modifiers, and anesthesia qualifying circumstances add-on codes that function as modifiers, do not count toward the limit.
- The cooling-off period for batched disputes was reduced from 90 calendar days to 30 business days.
- The guidance also lists the CPT code ranges that can be batched for anesthesiology, radiology, pathology, and laboratory services.
- Two new QPA audit final reports. In October, CMS posted final reports on two QPA audits of CareSource, Indiana (PDF) and the School Employees Retirement System, Ohio (PDF). These are only the second and third final QPA Audit Reports CMS has posted, and they cover January 1, 2022, through May 31, 2023.
- CareSource had findings related to missing disclosures, untimely QPA information, and calculating the QPA using usual and customary rates rather than contracted rates. It corrected these during the audit.
- The School Employees Retirement System (air ambulance only) had findings related to QPA disclosures and IDR-initiation language. CMS also observed that a secondary payer is not exempt from QPA disclosure requirements, even though the audit did not treat that as a violation.
- Both entities were directed to self-audit NSA-eligible claims and reimburse consumers where cost sharing was too high.
Taken together, these developments demonstrate that federal oversight of the No Surprises Act is continuing. CMS is publishing audit results, directing corrective action, and issuing detailed operational guidance, so plans and issuers should expect ongoing scrutiny of NSA compliance. At the same time, the move to the IDR Gateway, as finalized in the IDR Operations Final Rule, is the first major operational update the IDR system has seen since its inception. The tri-departments noted in the Federal IDR Operations Final Rule that they believe a centralized, secure platform with clearer rules on batching, eligibility, and dispute tracking could reduce ineligible disputes and make the process more transparent and predictable for all parties. Implementation will continue in phases, with additional guidance and functionality still to come, including open negotiation tools and the IDR Registry.
We continue to monitor developments related to the No Surprises Act and Federal IDR process. For more information on the No Surprises Act and Federal IDR, see our prior publications:
- No Surprises Here: Second Circuit Holds IDR Awards Should Be Enforced Administratively, and Not Through Private Plaintiff Lawsuits | Groom Law Group
- CMS Announces Updates Regarding IDR Operations and Portal | Groom Law Group
- The Departments Issue Final IDR Operations Rule | Groom Law Group
- No Surprise Bills for Patients, But Plenty of Complexity for Payers: An Update on the No Surprises Act | Groom Law Group
