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May 29, 2026 – Two helpings of Regs & Eggs this week! My colleague Kristen O’Brien and I just couldn’t wait to serve up a post on the Federal Independent Dispute Resolution (IDR) Operations final rule that the US Departments of Health and Human Services, Labor, and the Treasury (the Departments) released on May 28, 2026. Avid Regs & Eggs readers know that we’ve been waiting for this reg for a while and that it has been a long-standing item on the administration’s No Surprises Act regulatory “to-do list.” The proposed rule was published in the Federal Register on November 3, 2023. Much of the final rule responds to technical limitations that stakeholders have highlighted since the federal IDR process under the No Surprises Act began. These issues have led to challenges in correctly identifying which disputes are eligible for the federal IDR process and problems batching similar claims. Stakeholders have highlighted many other concerns about the IDR process, including enforcement, outliers to offers and payment determinations, and delays in award payments, but those topics were not in play for this rule, which focuses on the nuts and bolts of the IDR process. Without further ado, let’s dig in!
The question of whether a dispute is eligible for the federal IDR process remains a major concern for both payers and providers (the disputing parties) and the certified IDR entities (arbiters). It’s a tricky question, as many states have their own surprise billing laws, and only certain plans within each of those states are subject to those laws (the rest must follow the federal requirements).
The Departments finalized several policies that attempt to make it easier for everyone involved to make that determination.
First, the Departments finalized new requirements for disclosures that group health plans and health insurance issuers offering group or individual health insurance coverage must make at the time of the initial payment or notice of denial of payment. These disclosures include the business name of the plan, the business name of the plan sponsor (if applicable), and the registration identification number assigned to the health plan when it registers in a new IDR registry. The rule requires plans and issuers to communicate information by using claim adjustment reason codes (CARCs) and remittance advice remark codes (RARCs), as specified in future guidance, when providing any paper or electronic remittance advice to an entity that does not have a contractual relationship with the plan or issuer. All of that to say, the process should become clearer at the outset.
Speaking of the IDR registry, the Departments finalized their proposal to require plans and issuers subject to the federal IDR process to submit certain information to the Departments through a registry. The Departments made some adjustments to what information plans and issuers are required to submit on the registry, but the Departments hope that all this information will allow stakeholders to easily identify what plan is associated with each claim and whether the claim is eligible for the federal process.
The Departments also finalized proposals to require parties to include additional information on the notice of IDR initiation to help “confirm or update information necessary to continue negotiations and identify any information discrepancies that could impact eligibility for the Federal IDR process.” The final rule requires the party that did not initiate the dispute to formally respond to the initiating party and the Departments within three business days after the date of IDR initiation (and to note any objection to federal IDR process eligibility).
To make it easier for certified IDR entities to determine eligibility, the Departments finalized their proposal to give certified IDR entities an additional two business days to make an eligibility determination (for a total of five business days). Certified IDR entities must notify disputing parties and the Departments within five business days of determining a dispute is ineligible.
Finally, although it was not noted in the rule (since it wasn’t proposed), the Departments have publicly referenced the idea of an “IDR gateway,” which would be a new centralized federal digital platform that could track disputes as they go through the process and reduce the number of ineligible disputes. The gateway is something many stakeholders have said they are eager to hear more about.
To encourage open dialogue between parties prior to the initiation of the IDR process, the No Surprises Act mandates a 30-day open negotiation period. The departments finalized proposed changes to streamline the efficiency and effectiveness of the open negotiation process:
The Departments also finalized their proposal to enhance the content of the notice of open negotiation (with some minor modifications) and to require use of the federal IDR portal for disputing parties to exchange the open negotiation notice and the open negotiation response notice.
The Departments finalized multiple changes related to “batching,” which effectively allows a provider to lump multiple similar claims into one batch. Under current rules, multiple services can be put into a batch if the services meet the following criteria:
The Departments finalized the following changes to these rules:
The proposed rule would have limited the number of services (line items) that can be in a single batch to 25. The intent was to prevent extremely large batches and to address Department concerns that certified IDR entities might not be able to process larger groupings of claims within required deadlines. After receiving input from stakeholders that a limitation of 25 was too low, the Departments finalized a cap of 50 line items per batched dispute.
In the proposed rule, the Departments sought comment on how to define the statutory batching criterion of claims “related to the treatment of a similar condition.” Under the final rule, batches can satisfy this criterion by including:
The Departments stated in the proposed rule that batching can only be among the same self-insured group health plan (regardless of whether the plan makes payments through a third-party administrator. The Departments noted that while a given third-party administrator may administer multiple self-insured plans, the self-insured group health plan generally is the responsible party for payment or reimbursement of the qualified IDR items and services, and therefore batching can only be among the same self-insured health plan. The Departments finalized this provision as proposed.
In the proposed rule, the Departments solicited comments on the application and length of the cooling off period following a determination in a dispute consisting of multiple items and services batched by patient encounter or CPT code ranges. The Departments sought comments on alternative shorter periods, including a duration of one business day. In the final rule, the Departments shortened the cooling off period to 30 business days. The Departments acknowledged commenters’ concerns that cooling off periods may be perpetually stacked on top of each other, creating a never-ending period where new disputes cannot be initiated. The Departments stated that they intend to publish clarifying guidance about the finalized batching provisions that will include details on how the cooling off period should be applied. The Departments noted that they did not solicit comments on whether to shorten the cooling off period for single disputes and therefore did not finalize such a policy.
Under current guidance, the Departments allow inappropriately batched disputes to be resubmitted as properly batched or single disputes. In the final rule, the Departments removed the option to resubmit inappropriately batched disputes, effective 120 days after plans and issuers are required to register in the IDR registry.
There are two fees associated with the IDR process: an administrative fee that goes to the Departments and a fee that goes to the certified IDR entities. The Departments proposed a bunch of changes to the administrative fee, including:
The Departments decided not to finalize any of these policies. However, the Departments recalculated the fee under the existing methodology and came up with a much lower fee of $15, an 85% reduction to the current amount of $115. The fee must cover the total amount that the Departments expect to spend on carrying out the federal IDR process. While the Departments increased their total spending estimate from $100.2 million to $119.4 million, that increase is more than offset by a higher projection of the number of expected disputes.
The Departments believe that the new $15 administration fee made some of the other proposed changes unnecessary, and that the lower amount will improve the accessibility of the federal IDR process for small and rural providers.
The IDR process includes numerous timelines and deadlines, and the Departments have previously stated that those timelines can be modified in the case of extenuating circumstances at the Departments’ discretion. In the final rule, the Departments confirmed that they will determine whether an extension is necessary on a case-by-case basis. The Departments will post a public notice about any generally applicable extensions of time periods.
The rule’s official effective date is 60 days after it is published in the Federal Register (which hadn’t yet occurred at the time this blog post was published). However, not all of these new policies will be effective in the near term, and many require additional guidance in order to be fully fleshed out and implemented. In fact, in some cases it is unclear when exactly the policies will go into effect.
We’ve tried to create an effective “timeline” below, but a lot of the timing will depend on when the additional guidance is released:
We are still working our way through all the details in this technical reg. While the final rule does lay the groundwork for upcoming improvements to the IDR process, the long implementation timeline and the need for additional guidance to effectuate certain policies create some uncertainty about the overall impact of all these changes once they are eventually adopted.
Until next time, this is Jeffrey (and Kristen) saying, enjoy reading regs with your eggs.
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