Written by: Taylor A. Stonerock & Miranda A. Preston
On May 28, 2026, the Departments of Health and Human Services (HHS), Labor, and Treasury, along with the Office of Personnel Management (OPM), finalized updates to the Federal Independent Dispute Resolution (“IDR”) process under the No Surprises Act (“Act”)[1]. The Final Rule[2] is designed to address longstanding operational challenges that have plagued the IDR system since its initial launch in 2022.
For healthcare providers who rely on IDR to resolve out‑of‑network payment disputes, the Final Rule introduces important procedural changes that will affect how disputes are initiated, evaluated, and resolved.
The IDR System Under the No Surprises Act
The Act was enacted to protect patients from unexpected out‑of‑network medical bills, particularly in emergency settings or where patients have no meaningful choice of provider. To resolve payment disputes between providers and payers, the Act established the federal IDR process, an arbitration system in which a neutral decision‑maker selects one of the parties’ final payment offers as reimbursement to the provider.
While the framework was intended to promote fair and efficient dispute resolution, the system has faced significant strain. Since the Act went into effect in 2022, more than 5 million disputes have been submitted, far exceeding initial projections and creating delays and administrative burdens across the industry.[3]
Key Changes to the IDR Process
Reduction in IDR Administrative Fees
One of the most significant changes is the reduction in the administrative fee required to initiate an IDR dispute. Previously, the fee was $115 per party per dispute, but effective June 11, 2026, the fee was reduced to $15 per party per dispute.[4] This significantly lowers the cost barrier to pursuing IDR and may make arbitration financially worthwhile for providers in cases that previously would not have justified the expense.
Standardized Insurer Communication Requirements
Payers must now include standardized explanation codes—specifically Claim Adjustment Reason Codes (CARCs) and Remittance Advice Remark Codes (RARCs).[5] This means that health care providers should now be able to identify why a claim was underpaid or denied. This should enable billing teams to quickly determine whether the claim is IDR-eligible, and whether open negotiation is worth pursuing.
Enhanced Open Negotiation Process
The Act’s required 30‑business‑day open negotiation period remains in place, but payers must now provide additional information upfront, including the qualifying payment amount (“QPA”), plan identification details, and contact information for initiating open negotiation.[6] This should enable providers to immediately evaluate the payer’s position (particularly, the QPA), and decide whether to push for settlement, or proceed to IDR. Providers should consider developing standard counteroffer templates tied to QPA variances.
Stricter IDR Initiation and Eligibility Requirements
The Final Rule formalizes front‑end requirements, including: (1) submission of a complete Notice of IDR Initiation with documentation[7]; (2) tight response timelines (3 business days for the non‑initiating party); and (3) rapid eligibility determinations (5 business days).[8] For providers, this likely means that more disputes will be rejected early if documentation is incomplete. It should also mean that administrative delays will improve, but only for properly prepared submissions.
Expanded and Clarified Batching Rules
The Final Rule allows for broader batching of similar claims, generally up to 50 line items per dispute in certain circumstances.[9] Batching can significantly improve efficiency and reduce costs, especially for providers handling large volumes of similar claims. However, providers must pay careful attention to eligibility criteria and grouping rules to avoid rejection.
Creation of a Centralized IDR Registry
Payers will be required to register with HHS and the Departments of Labor, and Treasury, and provide related information regarding applicability and services covered.[10] This should result in fewer disputes against the wrong payer entity, and easier identification of responsible plans for IDR.
What the Rule Does Not Change
Importantly, the Final Rule does not substantively alter how arbitrators determine payment amounts. Ongoing litigation, particularly cases involving the weight of the QPA, continues to influence that analysis.[11] As a result, providers should not assume that outcomes in IDR will shift significantly based solely on this Final Rule.
Collectively, the changes implemented by the Final Rule shift the IDR process toward a more data‑driven, front‑loaded workflow—requiring providers to invest in better claim classification, documentation, and batching strategies, but offering greater efficiency and lower costs for those who adapt.
If you have questions about how the Final Rule applies to your organization, please contact please contact Miranda Preston or Taylor Stonerock.
[1] See Consolidated Appropriations Act, 2021, Pub. L. No. 116‑260 (Dec. 27, 2020).
[2] Federal Independent Dispute Resolution Operations, 91 Fed. Reg. 33,900 (June 4, 2026).
[3] See 91 Fed. Reg. at 33,901-02.
[4] Id. at 34,002.
[5] Id. at 34,022.
[6] Id. at 34,012.
[7] Id. at 34,023.
[8] Id. at 34,012-13.
[9] Id. at 34,014.
[10] Id.
[11] Id. at 33,901.; see also Tex. Med. Ass’n v. U.S. Dep’t of Health & Hum. Servs., 587 F. Supp. 3d 528 (E.D. Tex. 2022) (TMA I); Tex. Med. Ass’n v. U.S. Dep’t of Health & Hum. Servs., 654 F. Supp. 3d 575 (E.D. Tex. 2023), aff’d, No. 23-40217 (5th Cir. August 2, 2024) (TMA II); Tex. Med. Ass’n v. U.S. Dep’t of Health & Hum. Servs., Case No. 6:22-cv-450-JDK (E.D. Tex. August 24, 2023), Tex. Med. Ass’n v. U.S. Dep’t of Health & Hum. Servs., 120 F.4th 494 (5th Cir. 2024), and Tex. Med. Ass’n v. U.S. Dep’t of Health & Hum. Servs., Case No. 23-40605 (5th Cir. May 30, 2025) (collectively, TMA III); and Tex. Med. Ass’n v. U.S. Dep’t of Health & Hum. Servs., Case No. 6:23-cv-00059-JDK, (E.D. Tex. August 3, 2023) (TMA IV).
