By: HUB's EB Compliance Team

Recently, the Departments of Labor, Health and Human Services, and the Treasury, along with the Office of Personnel Management (collectively, the Departments), published a final rule overhauling how the Federal Independent Dispute Resolution (“IDR”) process operates under the No Surprises Act (“NSA”). The IDR process provides a mechanism for out-of-network providers and health plans to resolve payment disputes for certain claims subject to the NSA (generally, out-of-network emergency services, air ambulance services, and services provided by out-of-network providers at in-network facilities). Since launching in 2022, the volume of disputes has far exceeded what regulators expected, and this rule is the Departments' latest attempt to make the IDR process run more efficiently. The final rule is effective as of August 3, 2026, though many of its requirements will gradually phase-in over time.

What Prompted This Rule

The Federal IDR process has struggled to run efficiently since its inception. The Departments expected roughly 22,000 disputes per year; instead, parties submitted 489,000 disputes in the first year alone, and cumulative submissions have surpassed 5.1 million as of January 2026. Much of the backlog stems from unclear communication between the parties in dispute, inconsistent use of the required “open negotiation period”, and a high volume of disputes that turn out to be ineligible for the process altogether. The Departments first attempted to address these operational issues by proposing this rule back in 2023- the rule is now final and include modifications that address comments made by the public.

Key Changes Employers Should Know About

The final rule does not change who is covered by the No Surprises Act's surprise billing protections or how the Qualifying Payment Amount (“QPA”) is calculated. Instead, it focuses on the mechanics of the dispute process itself. The most significant changes include:

  1. Standardized payment codes. Plans and issuers must use standard claim adjustment reason codes (“CARCs”) and remittance advice remark codes (“RARCs”) to tell providers, on the remittance advice itself, whether a claim is or is not subject to the NSA. The goal is to cut down on disputes filed over claims that were never eligible for IDR in the first place. The Departments will specify the exact codes to use in future guidance, expected within six months of the rule's publication, with compliance required roughly four months after that.
  2. More information about the QPA. Plans and issuers must share additional QPA-related information in certain circumstances, including when cost sharing is based on the billed amount rather than the QPA, and must include a plan or issuer registration number once the new registry (described below) is operational.
  3. Open negotiation moves to the federal portal. The 30-business-day open negotiation period that must occur before a dispute can go to IDR must now be initiated and tracked through the federal IDR portal, not a payer's own proprietary system. The responding party has 15 business days to reply with required information.
  4. New plan and issuer registry. Self-insured group health plans, insurers, and Federal Employee Health Benefits (“FEHB”) carriers must register in a new federal IDR registry and keep their contact and plan information current. Each registrant receives an IDR registration number. The intent is to help providers identify the correct plan and reduce disputes filed against the wrong party. Registration will be required within 90 business days after the registry becomes available.
  5. Larger batched disputes. Providers may now combine up to 50 items or services into a single dispute, a new hard cap the Departments adopted after determining that a lower proposed limit of 25 was too restrictive (previously, there was no numerical cap at all). The rule also broadens which services (including certain anesthesiology, radiology, pathology, and lab claims) can be batched together. This could mean larger, more complex IDR determinations for plans to respond to.
  6. Lower administrative fee. The per-party administrative fee for filing an IDR dispute drops sharply, from $115 to $15, effective for disputes initiated on or after June 11, 2026. A lower fee may make it more economical for providers to file disputes, including for smaller-dollar claims, which could increase dispute volume even as other provisions aim to reduce it.

Why This Matters for Plan Sponsors

Most of the operational burden created by this rule falls on insurers and third-party administrators (“TPAs”) who manage claims and remittance systems on a plan's behalf. Self-insured plan sponsors should not assume that burden is entirely someone else's problem, however. The rule is explicit that delegating claims administration to a TPA does not relieve the plan sponsor of legal responsibility for compliance, including the new registry requirements. Self-insured plans will need to confirm that their registration reflects the plan sponsor's own legal name, not just the TPA's, and that someone is monitoring the process.

Plan sponsors should also expect increased scrutiny of vendor performance. Because open negotiation and IDR initiation will now run through a centralized federal portal, plan sponsors will have more visibility into how quickly and thoroughly their TPA or carrier is engaging with providers during that process, and more reason to ask questions if disputes are consistently mishandled or missed entirely.

Finally, this rule addresses the mechanics of the IDR process, but it does not address the underlying cost pressures driven by NSA claims and the trend of IDR outcomes favoring providers. The lower administrative fee, larger batching limits, and continued absence of firm penalties for missed deadlines mean employers should not expect IDR-related costs to disappear. In fact, dispute volume, and the administrative costs that come with it, may remain stagnant or even increase due to the lower administrative fees.

Plan Sponsor Action Items

  1. Confirm with your carrier or TPA that they are aware of the rule and have a plan to comply with the new CARC/RARC, registry, and portal requirements as applicable guidance and deadlines are announced.
  2. For self-insured plans, verify who will handle registration in the new Federal IDR registry, and confirm the plan sponsor's legal name and contact information will be accurately reflected.
  3. Watch for guidance from the Departments related to the specific CARCs/RARCs to use and the applicability dates for the portal-based open negotiation and registry requirements.
  4. Consider the possibility that IDR-related administrative costs and dispute volume may not decline in the short term, notwithstanding the lower per-dispute fee.

If you have any questions, please contact your HUB Advisor. View more compliance articles in our Compliance Directory.

NOTICE OF DISCLAIMER

Neither Hub International Limited nor any of its affiliated companies is a law or accounting firm, and therefore they cannot provide legal or tax advice. The information herein is provided for general information only and is not intended to constitute legal or tax advice as to an organization's or individual's specific circumstances. It is based on Hub International's understanding of the law as it exists on the date of this publication. Subsequent developments may result in this information becoming outdated or incorrect and Hub International does not have an obligation to update this information. You should consult an attorney, accountant, or other legal or tax professional regarding the application of the general information provided here to your organization's specific situation in light of your or your organization's particular needs.