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CMS Fact Sheet: Federal Independent Dispute Resolution Operations Final Rule
Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS]
[Guidance Overview] May 28, 2026 "These final rules will improve the functioning of the Federal IDR process by streamlining communication between payers, providers, and certified IDR entities and clarifying timelines and processes.... [T]he Departments are finalizing a requirement for payers to communicate information to providers by using 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.... [T]he Departments are finalizing several changes to the open negotiation requirements.... the Departments are finalizing a few amendments to the current batching provisions.... The Departments are also finalizing a revision to the types of extenuating circumstances in which the Federal IDR process time periods may be extended.... The requirement that payers communicate information using CARCs and RARCs and the modifications to the regulations addressing information to be shared about the QPA will take effect on the effective date of the final rules." MORE >> |
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