IDR Portal and Machine-Readable Files FAQ

April 26, 2022


On Friday, April 15, the Center for Medicare & Medicaid Services (CMS) launched the online IDR portal. The portal is a tool available to nonparticipating providers and health plans, after a 30-business day open negotiation period, when they are not able to agree on the out-of-network rate for services provided. The process is a part of the new consumer protections against surprise out-of-network balance billing, effective January 2022, under the No Surprises Act (NSA).

Providers who wish to dispute the out-of-network rate must initiate IDR proceedings within 4 business days after the open negotiation period has ended, except in limited circumstances. Disputing parties are encouraged to continue negotiations after initiating the IDR process. If they agree on an out-of-network rate prior to the certified IDR entity’s payment decision, the initiating party then notifies the Departments within 3 business days of the agreement and the negotiated rate applied as payment.

With the delay in the launch of the IDR portal, CMS expects a high volume of IDR requests may create a backlog. In addition, because the open negotiation period has expired for some claims with dates of services in early 2022, additional time is allowed for the initiation of the IDR process for these claims. The initiation notice must be submitted within 15 business days following the opening of IDR portal and the notices of initiation can be accessed here.

A CMS website page, available here, contains additional details regarding extensions due to extenuating circumstances, the role of the certified IDR entity, and the required information necessary for initiation.

Further information is expected from the Departments, especially after the IDR process is underway in the months ahead. WebTPA is ready to facilitate the IDR process with the information provided thus far and will continue to provide updates as we learn more.


On April 19, CMS issued FAQs regarding the Transparency in Coverage requirements for machine readable files. The FAQs address incorporating applicable rates on the in-network files, for specific items or services provided under “percentage-of-billed-charges” contracts if an exact dollar amount cannot be determined and those rates under alternative reimbursement arrangements that are not supported by the schema or require additional context to be understood. The FAQs are available here.

Our Technology Products Department is leading the initiative for the machine-readable files and is reviewing the additional details supplied by CMS.