U.S. Government Finalizes No Surprises Act Independent Dispute Resolution Operations Rule

On May 28, 2026, the U.S. Departments of Health and Human Services, Labor, and the Treasury as well as the Office of Personnel Management (the Departments) issued the Federal Independent Dispute Resolution (IDR) Operations final rule. The rule makes long-awaited process updates to the No Surprises Act (NSA) IDR process for adjudicating disputes on out-of-network billing for providers and payors. These changes will require changes in how stakeholders participate in IDR.

These regulations are focused on the NSA IDR process. They do not make any changes to other aspects of the NSA, such as the coverage of the law or the calculation of the Qualified Payment Amount (QPA), both areas of interest to stakeholders.

Furthermore, the Departments did not implement any new enforcement measures related to these new requirements. Payors and providers must continue to report violations to the Departments, which are responsible for addressing any noncompliance.

Key updates from the final rule are covered here.

IDR Administrative Fee

The final rule reduces the administrative fee owed to the Departments to $15 per party, per dispute — down from $115, a reduction of more than 85%. The Departments “determined that the administrative fee structure of one fixed administrative fee at a rate of $15 per party per dispute for all disputes addresses commenters’ concerns regarding equal access to the Federal IDR process.” Of note, there were no changes to IDR entity (IDRE) fees, which vary by federal contractor.

The new fee applies to disputes initiated on or after June 11, 2026.

The lower fee should make it economical for IDR disputes to be submitted for lower monetary value claims.

Use of CARCs and RARCs

The final rule requires payors to use claim adjustment reason codes (CARCs) and remittance advice remark codes (RARCs) for all claims, even those not subject to the NSA. The Departments stated that “it is equally important to understand when an item or service is not subject to these protections, so that parties can take appropriate steps to resolve payment issues and avoid submission of ineligible disputes to the Federal IDR process.”

The Departments indicated that they will set an applicability date for these requirements through guidance. They anticipate such guidance to be issued within six months of publication of the final rules and to take effect four months thereafter — so approximately 10 months after these final rules are published.

IDR Registry

The final rule requires payors to register with the Departments. Payors are required to disclose their legal name and whether they have opted in to state insurance regulation. Each registrant receives an IDR registration number, which “will help providers accurately identify plans, issuers, and [Federal Employees Health Benefits] carriers as well as their contact information, reducing the number of ineligible disputes initiated within the Federal IDR process and reducing the number of disputes incorrectly initiated against the wrong plan or issuer.”

The registry requirements become applicable 90 business days after the Departments issue guidance announcing that the supporting functionality has become available.

Changes to Open Negotiation

The final rule moves the open negotiation process onto the federal IDR portal. Both the open negotiation notice and the noninitiating party’s response must now be submitted through the portal.

Another key change is that within 15 business days of the open negotiation notice, the noninitiating party must now respond with specified information, including, where applicable, a statement and supporting documentation explaining why the item or service is not subject to the federal IDR process. The Departments warn “that if a party fails to furnish an open negotiation response notice containing all required information to the other party and the Departments, the Departments may review and determine whether enforcement action may be appropriate.”

These changes apply to disputes with open negotiation periods beginning 90 days after the Departments issue guidance announcing that the supporting portal functionality has become available, which the Departments expect to release on a rolling basis this summer and to take approximately 24 months to fully implement.

Changes to IDR Initiation

Within three business days of IDR initiation, the noninitiating party must now respond with any objection to the selected IDRE and any objection to the dispute’s eligibility for the federal IDR process.

The final rule also establishes a structured eligibility-review timeline. IDREs must determine eligibility — and notify the parties — within five business days of their selection.

These changes will become effective beginning 90 days after the Departments issue guidance.

Batching Rules

The final rule makes multiple changes to batching rules. Stakeholders can batch up to 50 items or services in a single dispute (up from 25).

To be eligible for batching, claims must meet several requirements:

• Items or services must involve the same payor;
• similar condition, satisfied in one of several ways —
  • a single patient treated during a single patient encounter;
  • different patients treated using the same or a comparable code;
  • for anesthesia, radiology, pathology, and laboratory services, items or services within the same CPT Category I code range;
• furnished within the same 30-business-day period (with an adjustment to a cooling-off period).

These changes will become effective beginning 90 days after the Departments issue guidance.

Stakeholders should monitor publication and the Departments’ guidance closely and begin preparing to operate within the revised frameworks.