On June 4, 2026, the Departments of Health and Human Services, Labor, and  the Treasury, together with the Office of Personnel Management, published a final rule (the “Final Rule”) revising the federal independent dispute resolution (“IDR”) process under the No Surprises Act (the “NSA”).

Background

Enacted as part of the Consolidated Appropriations Act, 2021, the NSA generally protects patients from surprise medical bills for out-of-network emergency services, certain non-emergency services furnished at in-network facilities, and out-of-network air ambulance services. These protections generally took effect January 1, 2022.

When neither a specified state law nor an applicable All-Payer Model Agreement determines the payment amount, the parties may use federal IDR following a 30-business-day open negotiation period. If negotiation fails, either party generally may initiate IDR during the following fourbusiness-day period. Each party submits an offer, and a certified IDR entity selects one after considering the qualifying payment amount (“QPA”)  and properly submitted information concerning the other statutory  factors. The QPA generally is based on the median contracted rate for the  same or a similar item or service in the applicable insurance market and  geographic region, adjusted for inflation.

Key Considerations

Expanded disclosures. Effective August 3, 2026, plans and issuers must provide the QPA and related information with an initial payment or notice of denial even when the provider’s billed amount, rather than the QPA, is used to calculate participant cost sharing. The

disclosures must also include the legal business name of the selfinsured plan or issuer, the plan sponsor’s legal business name, and the plan’s or issuer’s federal IDR registration number once assigned. The Final Rule also requires plans and issuers to use specified claim

adjustment reason codes (“CARCs”) and remittance advice remark codes (“RARCs”) on paper and electronic remittance advice sent to noncontracted entities. Under subsequent agency guidance, plans and issuers must use the specified RARCs for items and services

furnished on or after January 1, 2027.

Portal-based negotiation and eligibility review. Once the necessary portal functionality is available, parties will submit open negotiation notices, responses, and supporting documentation through the federal IDR portal. The receiving party must respond by the 15th

business day of the 30-business-day negotiation period. A certified IDR entity generally must determine eligibility within five business days after its final selection. These requirements will apply to disputes with open negotiation periods beginning 90 days after the agencies

announce that the supporting functionality is available.

Batching and bundled arrangements. The Final Rule permits batching when qualified IDR items or services involve a single patient encounter billed on the same claim form, the same or comparable service codes, or specified anesthesiology, radiology, pathology,

and laboratory services within the same Category I CPT code range identified in agency guidance. A batch may contain no more than 50 qualified IDR items or services, and the cooling-off period for batched disputes decreases from 90 calendar days to 30 business days. The Final Rule separately defines a bundled payment arrangement,

which may be submitted as a single payment determination and is not generally subject to the batching requirements. The agencies have announced that the revised batching provisions will apply to disputes with open negotiation periods beginning on or after

November 1, 2026.

Lower administrative fee. The nonrefundable administrative fee decreased from $115 to $15 per party for disputes initiated on or after June 11, 2026. Beginning August 3, 2026, a party that does not timely pay the administrative fee or, for an eligible dispute, the certified IDR entity fee will not have its offer considered and will remain liable for

the unpaid fee.

▷ Federal IDR Registry. Self-insured plans, issuers, and Federal Employees Health Benefits Program carriers subject to federal IDR will be required to register and obtain a federal IDR number. Fully insured group plans will not register separately from their issuers.

Registration will be due by the later of 90 business days after the agencies announce that the registry is available or the date the plan or coverage becomes subject to federal IDR. A TPA may register for a self-insured plan, but the plan remains responsible for compliance.

Registration information must be updated within 30 calendar days after a change and confirmed annually during the fourth quarter.

Employer Impact

Federal IDR activity has substantially outpaced the agencies’ projections. Although the agencies initially estimated that approximately 22,000 disputes would be initiated during the first year of implementation, CMS reports that more than 6.3 million disputes were initiated between April, 15, 2022, and May 31, 2026. This continued growth highlights the potential financial and administrative significance of the federal IDR process for employers sponsoring self-insured plans. In light of the Final Rule, plan sponsors can begin by confirming that their TPAs have implemented the disclosure requirements effective as of August 3, 2026, and are preparing for the November 1, 2026 batching changes and

January 1, 2027 RARC requirements. Other near-term priorities include assigning responsibility for federal IDR registration, gathering the required plan-specific information, and reviewing the plan’s QPA methodology before the current enforcement relief expires on October 1, 2026.

Administrative services agreements also warrant review to address IDR notices, payment authority, fees, reporting, registration, and responsibility for missed deadlines or inaccurate submissions.

Conclusion

Employers sponsoring self-insured plans should coordinate with their TPAs to implement the Final Rule’s phased requirements, prepare for registration and portal changes, and establish regular oversight of IDR activity. Because delegation to a TPA does not eliminate the plan’s compliance obligations, continued monitoring of agency guidance and the pending TMA III litigation remains important.

For more information regarding the No Surprises Act, please contact Mike Holley, Vice President of Life & Health for Dimond Bros Insurance, at mike.holley@dimondbros.com

The content of this article is not intended to be exhaustive nor should any discussion or opinions be construed as legal advice. Readers should contact legal counsel for legal advice. TRUE Network. All Rights Reserved.