Final Federal Independent Dispute Resolution Operations Rule Under the No Surprises Act

The US Departments of Health and Human Services, Labor, and the Treasury, along with the Office of Personnel Management, (collectively, Departments) have issued a final rule (Final Rule) updating the federal independent dispute resolution (IDR) process established under the No Surprises Act (NSA). The Final Rule is intended to address the substantial administrative backlog and operational challenges that have plagued the IDR system since its inception in 2022 due to the unexpectedly high volume of submissions.

The Final Rule focuses primarily on procedural and operational reforms, rather than substantive changes to payment methodology that have been the subject of litigation efforts, most notably by the Texas Medical Association, and that remain subject to some enforcement discretion while rulemaking on the payment methodology continues. With this Final Rule, the Departments seek to improve efficiency, standardize communications, accelerate eligibility determinations, and reduce administrative costs for providers and payors. The Final Rule becomes effective 60 days after publication in the Federal Register, which occurred on June 4, 2026.

Background

The NSA prohibits certain surprise medical bills and balance billing practices relating to the provision of out-of-network emergency medical services, nonemergency services provided by out-of-network providers in in-network facilities, and out-of-network air ambulance providers. It also establishes an IDR process that involves arbitration to resolve payment disputes between certain out-of-network providers and health plans when business negotiations fail. Under the existing framework, parties engage in a 30-business-day open negotiation period before either party may initiate the IDR process. 

Since the NSA’s implementation, more than 5.1 million dispute submissions have been submitted to IDR, far exceeding federal projections and creating significant delays. 

Standardized Communication Requirements for Payors

Providers have argued that they lack sufficient information to determine whether a claim is eligible for the IDR process and whether pursuing arbitration is worthwhile. To address this concern, the Final Rule requires payors to use standardized claim adjustment reason codes and remittance advice remark codes when issuing any remittance advice to an entity that does not have a contractual relationship with the payor (i.e., is out-of-network with that payor). This change is intended to clarify when an item or service is not subject to NSA protections to avoid the submission of ineligible disputes by such providers to the IDR process. The rule finalizes other requirements for payors to provide additional identifying information with their initial payment or denial, such as their legal name and Federal Employees Health Benefits carrier.

An effective date for these requirements will be established in guidance issued by the Departments within six months of publication of the Final Rule (i.e., by December 4, 2026).

IDR Registration Requirement

The Departments note in their rulemaking that providers and IDR entities have struggled to identify the correct responsible payor for a particular claim and to determine whether a claim was subject to IDR. Under the Final Rule, payors subject to the IDR process must register with the Departments and obtain a unique federal IDR registration number. The registration number is intended to improve identification of responsible payors and facilitate eligibility determinations, thereby reducing submission of ineligible disputes to the IDR process.

Eligibility Determinations — Faster Turnaround

Under the Final Rule, the non-initiating party must respond within three business days of IDR initiation with any objections to the selected IDR entity or to the dispute’s eligibility for the IDR process. Additionally, IDR entities must determine dispute eligibility, and notify the parties of such eligibility, within five business days of selecting an arbitrator for that dispute. 

When an IDR entity requests additional information, parties must respond within five business days. If a party fails to respond, the IDR entity may proceed without the information if feasible or close the dispute if the information is deemed necessary to its continuation.

‘Batching’ Claims

The No Surprises Act and its implementing regulations give an initiating party the chance to “batch” multiple items or services into one dispute, even if they were part of different payment determinations. In an effort to reduce administrative costs and further improve efficiency, the Final Rule finalizes several changes to the circumstances under which multiple claims may be batched into a single IDR dispute. Specifically, providers will be able to batch up to 50 claims in a single dispute (an increase from the current 25 claims) if the claims satisfy certain requirements, including:

• Items or services involve the same payor.
• The claims involve a similar condition — e.g., a single patient treated during a single patient encounter, different patients treated using the same or a comparable code, or for anesthesia, radiology, pathology, and laboratory services, items or services within the same CPT Category I code range.
• The claims must be furnished within the same 30-business-day period or have open negotiation periods ending within the 90-calendar-day suspension period (the “cooling-off period”).

The new batching rules will be effective 90 days after the Departments issue additional guidance regarding the functionality to support batching.

Administrative Fees

To improve equal access to the federal IDR process, the Final Rule reduces the administrative fee from $115 per party to $15 per party. The decreased fee will be effective on or after June 11, 2026. This decrease is likely to lower the bar to entry to the IDR process for smaller providers.

Additionally, the Final Rule codifies existing agency guidance providing that a party’s offer is not considered received for purposes of the IDR process requirements if that party fails to timely pay the administrative fee or the certified IDR entity fee. The nonpaying party remains responsible for its fees even if its offer is disregarded. 

Extension of Time Periods for Extenuating Circumstances 

The Final Rule confirms that the Departments will determine whether a deadline extension for any IDR process is warranted only on a case-by-case basis. The Departments will post a public notice about any generally applicable extensions, such as if there were a public emergency that warranted broader extension relief to a category of IDR participants.

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The Goodwin Healthcare team will continue to monitor proposed rules and guidance under the No Surprises Act. For more information on the issues discussed in this alert, please contact the authors or reach out to Goodwin’s Healthcare Regulatory and Compliance group or the Goodwin lawyer with whom you typically consult.

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