New Final Rule Governing Independent Dispute Resolution Operations under the No Surprises Act Seeks to Improve Efficiency in Out-of-Network Reimbursement Disputes by Fixing Eligibility Issues

On May 28, 2026, the U.S. Departments of Health and Human Services, Labor, and Treasury (the “Departments”) promulgated a final rule governing Independent Dispute Resolution (“IDR”) under the No Surprises Act, 42 U.S.C. § 300gg-111, et seq. (“NSA”). The final rule, published in the Federal Register today, largely adopts the 2023 proposed rule with modifications mostly focused on arbitrators’ eligibility determinations:

• Health benefit plans must now use NSA-specific claim adjustment reason codes (CARCs) and remittance advice remark codes (RARCs) when processing out-of-network providers’ reimbursement claims. The Departments declined to adopt penalties to enforce plans’ compliance with this requirement but will continue to monitor it.

• Plans must also now register with the Departments and provide certain information to give the Departments more oversight and help providers identify and negotiate with the correct entity and ensure eligibility of a dispute before commencing IDR.

• Initiating parties must now use the IDR portal to notify both opponents and the Departments of commencement of open negotiations. The 30-day clock before escalating the dispute to formal IDR proceedings begins to run from the date of that notice. The final rule largely adopts the twelve notice-content requirements in the proposed rule.

• Batching items and services in a single IDR proceeding will be permitted where: (1) they are provided to the same patient in the same patient encounter/admission involving consecutive dates of service; (2) they are provided to multiple patients but billed under the same code; and (3) anesthesiology, radiology, pathology, and laboratory items and services are provided to one or more patients under service codes in the same Category I CPT code section. To help arbitrators manage workflows and project costs, however, batched determinations cannot exceed 50 items and services in a single IDR proceeding.

• Arbitrators will have 5 days from their selection to determine eligibility and notify both the parties and the Departments of their decision. If the arbitrator needs more information, the parties must provide it within 5 business days at the risk of either (a) the arbitrator determining eligibility without the additional information or (b) closing the dispute altogether.

• Mandatory administrative fees are dropping from $115 per party per dispute to just $15—a significant departure from the proposed rule, which considered an increase to $150. The trade-off for the lower administrative fee is that, if a party has not paid the administrative fee by the time its offer submission is due, the arbitrator will not consider its offer, and the party will still be responsible for both the administrative fee and the arbitrator’s fee.

• There are new provisions to extend IDR deadlines in “extenuating circumstances,” like when the IDR portal has technological issues, or a provider submits a large volume of claims to IDR. This should provide some relief to arbitrators, who already spend the overwhelming majority of their time on complex eligibility determinations.

If you have questions about this new final rule, please do not hesitate to contact Andrew H. Selesnick or George S. Scoville III.

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