On May 28, 2026, the U.S. Department of Health and Human Services (HHS), U.S. Department of Labor (DOL), and U.S. Department of the Treasury (Treasury), along with the U.S. Office of Personnel Management (OPM), finalized operational changes to the federal independent dispute resolution (IDR) process under the No Surprises Act (NSA). The final rule, CMS-9897-F, aims to improve how out-of-network payment disputes are processed through the federal arbitration system by standardizing communications, clarifying timelines, updating batching, reducing administrative fees, and creating a new payor registry and centralized IDR infrastructure.
CMS and HHS frame the changes as necessary to address a process that has received more than five million disputes since launch and that has created backlogs, increased costs, and operational strain for stakeholders. This article highlights key takeaways from the federal IDR final rule and explores how healthcare providers and payors can adapt to the changes.
Payors Required to Provide More Upfront Information
A central element of the final rule is a strengthened front-end disclosure framework. When issuing an initial payment or denial for NSA-governed claims, payors must now include eligibility indicators using specified claim adjustment reason codes (CARCs) and remittance advice remark codes (RARCs) in remittance advice to noncontracted providers. In addition, payors are required to disclose key identifiers, including the legal name of the plan or issuer, the self-funded plan sponsor (if applicable), and, once operational, the payor’s IDR registration number, along with instructions directing providers to initiate open negotiation through the federal IDR portal.
These updates are intended to help enable earlier and more accurate IDR eligibility assessments and qualifying payment amount (QPA) analysis, reduce disputes filed against the wrong entity, and improve documentation quality before open negotiation begins.
Open Negotiation Is Now More Formal & Traceable
The rule formalizes and centralizes the 30-business-day open negotiation period. Initiating parties must submit notices through the federal IDR portal to both the opposing party and HHS/DOL/Treasury/OPM (the Departments), and this submission marks the beginning of the negotiation period. CMS also requires a response notice from the receiving party by day 15.
This change was made with the intent to address concerns that open negotiation was often perfunctory or undocumented. The Departments’ aim is to transform the process into a trackable, enforceable step by moving it into the IDR portal.
Batching Rules Are Updated With New Guardrails
The final rule expands flexibility for batching while imposing clear limits. CMS now permits batching for:
- Items and services for a single patient on the same or consecutive dates billed on one claim
- Services for one or more patients under the same or comparable service codes
- Specified anesthesiology, radiology, pathology, and laboratory services within the same Category I CPT section
CMS also caps batched disputes at 50 line items. This represents a shift from the more restrictive proposal and should improve efficiency for high-volume specialties. The 50-line cap is potentially more workable than the proposed 25-line threshold, reflecting stakeholder feedback on the economics of complex claim sets. Even so, batching remains tightly constrained, requiring disciplined claim grouping logic and stronger governance over resubmissions, cooling-off periods, and line-item construction.
Eligibility Reviews Will Be Expedited
Certified IDR entities must now determine eligibility within five business days of selection and notify both parties and the Departments. If additional information is needed for eligibility, conflict checks, or the payment determination, parties must respond within five business days. Failure to respond allows the IDR entity to proceed without the information or close the dispute if it cannot move forward.
This change targets what CMS identified as the primary source of delay: the complexity of eligibility determinations. In practice, it heightens scrutiny on incomplete submissions and elevates the importance of precise documentation, accurate eligibility review, and disciplined response workflows.
Administrative Fees Are Reduced
The Departments finalized an administrative fee of $15 per party, per dispute, down from $115 previously. The lower fee applies to disputes initiated on or after five business days after publication of the final rule, with the Departments invoking good cause to waive the standard delayed effective date. CMS characterizes the lower fee as a measure to preserve access to IDR while maintaining a self-sustaining system. The rule also codifies that a party that fails to pay the administrative fee or the certified IDR entity fee by the offer deadline will still be financially obligated to pay the fee, but the party’s offer will not be considered received.
A New IDR Registry & Gateway Should Improve Payor Identification
Payors subject to federal IDR must register with the Departments, submit required coverage and applicability details, and obtain an IDR registration number. This identifier will be used across disclosures and the federal IDR portal, enabling certified IDR entities and regulators to support eligibility determinations and enforcement. CMS has aligned this with the phased rollout of a centralized IDR Gateway, which should improve long-standing challenges in accurately identifying the correct payor, plan type, and responsible party, particularly in self-funded arrangements and among plans with shared branding.
Where the Federal IDR Rule Falls Short for Providers
A key unresolved issue for providers remains QPA transparency and methodology. While the rule adds disclosures around IDR eligibility and payor identity, it doesn’t address ongoing concerns with how payors calculate the QPA, the benchmark central to both patient cost-sharing and IDR outcomes.
The rule also leaves unaddressed the lack of an enforcement framework for payor noncompliance with IDR awards. It doesn’t clarify how regulators will respond when payors fail to remit payments post-determination, nor does it adopt the proposed federal backstop for eligibility determinations during periods of systemic delay.
Where the Federal IDR Rule Falls Short for Payors
For payors, the rule strengthens intake discipline but does little to curb inflationary IDR use. A KFF analysis1 of the federal IDR process through mid‑2024 indicates that providers initiated the majority of disputes and were successful in a significant share of cases, reflecting a consistent pattern in which providers challenge payor reimbursement levels they view as falling below appropriate market-based compensation and contractual expectations.
How Should Healthcare Executives Respond to the Federal IDR Rule?
The clear takeaway for healthcare executives is that operational readiness is now mission-critical. Providers and payors should reassess remittance workflows, eligibility protocols, open negotiation governance, batching strategies, fee controls, and dispute-response timelines to align with evolving requirements, while preparing for a more structured portal environment and eventual transition to the IDR Gateway.
At the same time, the broader debate remains unsettled. QPA methodology, arbitration variability, cost inflation dynamics, private equity-backed provider behavior, and enforcement expectations continue to drive uncertainty and are likely to intensify as dispute data from 2024 to 2025 mature and ongoing litigation and regulatory guidance further shape the QPA framework.
How Forvis Mazars Can Help With Federal IDR Changes
Our professionals at Forvis Mazars can help healthcare organizations evaluate complex policy and reimbursement changes in the context of operational, financial, and strategic decision making. For providers and health systems, this includes helping understand the revenue cycle implications of new federal IDR requirements, strengthening dispute intake and batching logic, refining open negotiation and arbitration workflows, and evaluating the downstream reimbursement impact of evolving NSA implementation. If you have questions about how the federal IDR operations final rule may affect your organization, please reach out to our team today to discuss your unique considerations.
- 1“The Performance of the Federal Independent Dispute Resolution Process Through Mid-2024,” kff.org, May 30, 2025.