Compliance News | September 8, 2026
The Federal IDR Team, which includes the Departments of Labor, Health and Human Services, and the Treasury, continue to work to implement the IDR operations final rule. The Centers for Medicare & Medicaid Services (CMS) on behalf of the Federal IDR Team is providing ongoing information regarding the updated IDR process. Recently, it announced that:
In addition, the Federal IDR Team released an Implementation Timeline Guide to clarify the applicability dates and the implementation approach for the various provisions under the final rule.
The No Surprises Act, which became applicable to most plans in 2022, established the federal IDR process to resolve certain payment disputes between payers and providers involving out-of-network items and services. (See our insights, “New Law Requires Transparency and Prohibits Surprise Billing” and “The No Surprises Act Requires Changes to Your Plan Coverage.”)
On June 4, 2026, the Departments of Labor, Health and Human Services, and the Treasury (collectively, the Departments), along with the Office of Personnel Management, issued a final rule intended to streamline and standardize IDR operations through updated requirements for claims adjudication communications, open negotiations, batching, eligibility determinations, administrative fees and other procedural aspects of the federal IDR process. The final rule also transitions open negotiations and federal IDR activities to the IDR Gateway. (For more information about the final rule and background on IDR implementation, see our insight, “Final Rule on Independent Dispute Resolution Operations.”)
The final rule’s effective date is August 3, 2026. Many provisions apply either on the effective date or 90 days later, on November 1, 2026, while others will become applicable only after future guidance is issued and supporting functionality is available.
Among other changes, the final rule provides for the transition of the federal IDR process from single-use web forms to the new IDR Gateway. The IDR Gateway is expected to launch in November 2026, with additional functionality implemented on a rolling basis. (See our insight, “IDR Operations Update: A New Gateway and Guidance on Codes.”)
As the functions supporting the relevant provision are operationalized, the Federal IDR Team will provide notice to the public and to disputing parties about the availability of additional functionality supporting the provision as well as an applicability date.
On August 14, 2026, the Federal IDR Team announced that all prospective IDR Gateway users can begin creating accounts effective September 15, 2026. Organizations that manage IDR disputes should designate at least one IDR Gateway administrator (CMS recommends at least two and no more than 10) to establish and manage their organization's account. The Federal IDR Team will email administrators instructions for creating an account and configuring their organization’s profile. The Federal IDR Team also released a detailed IDR Gateway Administrator User Guide to assist organizations with the account registration process.
Plan sponsors that use a third-party administrator (TPA) or another service provider to manage IDR disputes do not need to create an IDR Gateway account. However, they should confirm that their service provider has registered for and maintains an IDR Gateway account.
To reduce the IDR administrative burden and improve the efficiency of the process, the federal IDR process allows parties to batch certain items and services into a single IDR proceeding. The final rule makes significant changes to the batching rules that are intended to increase efficiency, reduce costs and ensure that batched items and services have a "clear organizing principle." The final rule, effective August 3, 2026, indicated that the new batching rules would be applicable 90 days thereafter, or November 1, 2026.
On August 3, 2026, the Federal IDR Team issued a notice announcing that the final rule’s batching provisions will apply to batched disputes with open negotiation start dates on or after November 1, 2026. Starting on that date, there will be a limit of 50 items and services that may be batched together in a single dispute. Note, under the final rule, items and services furnished within the same 30-business day period may be batched if they:
The notice also announced that a payment determination for a batched dispute with an open negotiation start date on or after November 1, 2026, will trigger a 30-business-day cooling off period during which the party that initiated the federal IDR process may not submit a subsequent federal IDR dispute involving the same other party with respect to a claim for the same item or service that was the subject of the prior payment determination.
Plan sponsors should stay abreast as the Departments continue to issue information related to IDR operations.
Sponsors of plans that directly administer their IDR process will need to comply with the new process requirements as they become applicable. Those that rely on an insurer or TPA will want to confirm the process is being updated in a timely and accurate manner.
Segal will highlight updates on IDR operations as they become available.
This page is for informational purposes only and does not constitute legal, tax or investment advice. You are encouraged to discuss the issues raised here with your legal, tax and other advisors before determining how the issues apply to your specific situations.