New CMS Guidance for Errors Identified after Dispute Closure

On June 6, 2025, the Centers for Medicare & Medicaid Services (the Departments) released Federal Independent Dispute Resolution (IDR) Technical Assistance for Certified IDR Entities and Disputing Parties that details the appropriate actions to take when an error is identified after a dispute has been closed. Read the full report here.

The Departments define three types of errors that could cause an entity to request a dispute be reopened:

• Clerical
• Jurisdictional
• Procedural 

Clerical Errors Eligible for Reopening 

A clerical error, as defined by the Departments, may refer to a mistake made by an IDRE such as a typographical error, miscalculation, or a technical issue within the Federal IDR portal. 

An example of a request that the Departments may approve of is an entity inadvertently issues a final determination with the incorrect prevailing party listed. If this occurs, the entity should send a request to reopen the dispute to CMS. 

If the reopening is approved, the entity is expected to rescind the previous determination, adjust accordingly, and reissue a corrected decision.  

Jurisdictional Errors Eligible for Reopening 

The Departments define a jurisdictional error as an incorrect eligibility decision that either results in a determination made on ineligible or eligible claims receiving a closure notice.  

Examples of Jurisdictional errors that may result in reopening involve: 

• An item or service furnished during a plan year beginning prior to January 1, 2022
• An item or service subject to an All-Payer Model Agreement or a Specified State Law
• An item or service payable by Medicare, Medicaid, CHIP, or TRICARE, Indian Health Service, Veterans Affairs Health Care, short-term limited duration insurance, or excepted benefits
• An item or service furnished by a participating provider, facility, or air ambulance services provider. 

If the reopening is approved, the entity will be required to rescind any previous determination and replace it with a notification of closure. 

Procedural Errors Eligible for Reopening

According to the Departments, a procedural error occurs when a certified IDR entity makes a determination on claims that did not follow the proper procedural steps to satisfy all timeline and documentation requirements. This can also occur if an entity closes a dispute inappropriately when all requirements are satisfied.

Examples of Procedural errors eligible for reopening include:

• A payment determination is rendered when the notice of initiation is not shared with the non-initiating party on the same it is submitted to CMS
• A payment determination is rendered when an identical claim was submitted with a different entity and already received an outcome.
• A withdrawal request is submitted prior to a decision being rendered, but it is not registered until after a decision has been made. 

If the reopening is approved, the entity will be required to rescind any previous determination and replace it with a notification of closure. If an incorrect closure was made instead of a decision, once the dispute is reopened, the claim can proceed accordingly.

Reopening Requests

The entity must submit any reopening requests to CMS for consideration and approval. If a party needs to bring a case to CMS’ attention, they should first contact the entity responsible for the determination so they can make the request. If the entity does not reply, a complaint can be made to CMS, notifying them of the entity’s lack of action.  

If a reopening request is pending, any payment timeline will be extended 30 calendar days from the release of the corrected decision.