Compliance News | July 29, 2026
As required by the recently issued final rule on independent dispute resolution (IDR) operations under the No Surprises Act, the Centers for Medicare & Medicaid Services (CMS) has provided an update on the status of the new IDR portal known as the IDR Gateway. CMS has also provided guidance about remittance advice remark codes (RARCs).
Most plans became subject to the No Surprises Act in 2022. The No Surprises Act prevents providers from balance billing patients who receive emergency services in the emergency department of a hospital, at an independent free-standing emergency department and from air ambulances. The law also protects patients who receive certain non-emergency services from an out-of-network provider at an in-network facility. (See our insights, “New Law Requires Transparency and Prohibits Surprise Billing” and “The No Surprises Act Requires Changes to Your Plan Coverage.”)
The law established the federal IDR process to settle payment disputes between payers and providers for out-of-network claims.
The final rule, which the Departments of Labor, Health and Human Services, and the Treasury and the Office of Personnel Management (collectively, the Departments) issued on June 4, 2026, provides enhanced standards for claims adjudication communications, open negotiations, batching, eligibility determinations, administrative fees and other procedural requirements during the IDR process. Standardizing IDR processes is intended to reduce delays and costs and increase efficiency, including lowering the number of ineligible claims entering the system and facilitating the proper handling of claims by the entity responsible.
Among other things, under the final rule, payers must use specific claim adjustment reason codes (CARCs) and remittance advice remark codes (RARCs) when they provide any paper or electronic remittance advice to an entity that does not have a contractual relationship with the payer.
As required by the final rule, open negotiations and IDR will run through a federal IDR portal and proprietary portals will no longer be used. The applicability of the various provisions of the final IDR operations rule is contingent upon the date the related requirements become functional under the federal IDR portal.
For more information about the final rule and background on the IDR implementation, see our June 5, 2026 insight, “Final Rule on Independent Dispute Resolution Operations.”
On July 15, 2026, CMS announced that the federal IDR process will transition from a single-use web form to the new IDR Gateway, which will provide a secure, centralized platform that parties can use to manage disputes.
Through the IDR Gateway, users will be able to:
The IDR Gateway will also bring important new security features, including identity verification processes and protocols that permit only U.S.-based users to access the federal IDR process.
Organizations and individuals that process disputes, represent parties or submit IDR web forms in the current federal IDR process will be required to sign up to manage disputes in the IDR Gateway. If they use a third-party administrator (TPA) or another organization to process disputes, they do not need to sign up for the IDR Gateway. However, they must ensure the TPA or organization responsible for managing dispute-processing activities signs up for an IDR Gateway account.
Details about signing up for the IDR Gateway are coming soon. Until then, entities should continue using the federal IDR web forms.
The new IDR Gateway is expected to launch in late 2026.
On July 17, 2026, CMS issued Guidance on Required Remittance Advice Remark Codes Related to the No Surprises Act. The guidance identifies the specific RARCs that must be used and the circumstances in which to use them to communicate information about whether an item or service is subject to the No Surprises Act’s surprise billing and federal IDR process provisions. The guidance also provides technical instructions to facilitate their use.
Use of the RARC codes will be incorporated into the official industry code set by November 1, 2026, and will be required to be used for items and services provided on or after January 1, 2027.
For now, plans and issuers may continue to choose the CARC they think is most appropriate for any claim adjustment.
Plan sponsors should stay abreast of IDR developments as the Departments continue to issue information related to IDR operations. Sponsors of plans that directly administer their IDR process will need to ensure they comply with the new process requirements as of the various applicability dates. Those that rely on a TPA will want to monitor the TPA for compliance.
Implementation guidance for the IDR operations rule is expected to be issued by the Departments incrementally over the coming months. Segal will continue to provide updates as new information becomes 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.