CMS Convenes Certified Independent Dispute Resolution Entity Leaders to Discuss Ways to Improve the Federal Program
On Thursday, October 1, 2026, the Centers for Medicare & Medicaid Services (CMS) convened leaders from across the federal government and from certified independent dispute resolution (IDR) entities to discuss issues impacting the federal IDR process. CMS Administrator Dr. Mehmet Oz, Department of Labor Assistant Secretary Daniel Aronowitz, and officials from the Departments of Health and Human Services, Labor, and the Treasury (the Departments) met with representatives from all certified IDR entities to address the increasingly high IDR-associated costs affecting the United States healthcare system. The ideas discussed in the meeting build on the system reforms that were a part of the Federal IDR Operations final rule as well as the fundamental technological evolution of the Federal IDR Portal into the IDR Gateway, which will launch in late 2026.
Progress and Emerging Trends
The Federal IDR process, established by the No Surprises Act, shields and protects patients from many common types of surprise medical billing by enabling independent arbitrators — also known as certified IDR entities — to adjudicate out-of-network payment disputes between healthcare providers and plans and insurers when they cannot otherwise reach an agreement. The process was expected to reduce net costs to the U.S. healthcare system. Since it began in April 2022, the federal IDR process has received and closed more than 7 million disputes — far exceeding expectations. However, the process has encountered delays and unexpected costs. While the Departments and certified IDR entities have made tremendous progress on the timeliness of handling disputes, IDR case volume continues to grow, and associated costs continue to rapidly increase.
As the process has evolved, users of the IDR process have raised concerns about ineligible disputes, unclear IDR entity determination rationales, and delayed payment or nonpayment after certified IDR entity determinations. CMS convened the certified IDR entities to gain additional insights into these trends from the organizations directly responsible for adjudicating disputes and to better understand what can be done to resolve these concerns.
Insights From Certified IDR Entities
Certified IDR entities — as the adjudicating parties — are uniquely positioned to suggest regulatory and operational changes that can address these effects and ensure a fair and efficient program. Participants shared their experiences and discussed how their decision-making and processes impact the program operations and outcomes.
Protecting Consumers and Strengthening the Federal IDR Process
The No Surprises Act has succeeded in its primary objective: protecting American consumers from surprise medical bills. The Departments and certified IDR entities expressed their shared responsibility to improve the federal IDR process. The participants, representing all active certified IDR entities, are committed to enhancing their processes in collaboration with the Departments.
The Departments will consider the insights offered by the certified IDR entities as they continue to explore all available regulatory and operational solutions.
Participating certified IDR entities included:
- Capitol Bridge LLC
- C2C Innovative Solutions Inc.
- Dane Street LLC
- EdiPhy Advisors LLC
- Federal Hearings and Appeals Services Inc.
- iMPROVe Health
- Island Peer Review Organization (DBA: IPRO)
- Keystone Peer Review Organization Inc. (DBA: Acentra Health)
- Livanta LLC (DBA: Commence)
- Maximus Federal Services Inc.
- MCMC Services LLC
- Medical Evaluators of Texas (DBA: MET Healthcare Solutions)
- National Medical Reviews (DBA: National Medical Reviews Inc.)
- Network Medical Review Company (DBA: National Medical Review Company Ltd.)
- Physio Solutions LLC (DBA: medlitix)
- ProPeer Resources LLC
- Provider Resources Inc.