WASHINGTON, D.C. — Federal regulators have finalized sweeping changes to the No Surprises Act’s dispute resolution system, reducing arbitration fees by more than 85% and revising procedures intended to address a backlog that has generated more than 5 million payment disputes since the program launched in 2022.
The rule affects the Federal Independent Dispute Resolution process, which is used by insurers and healthcare providers to settle certain out-of-network payment disputes without involving patients.
The Departments of Health and Human Services, Labor and Treasury, along with the Office of Personnel Management, stated that the changes are designed to reduce administrative costs, improve processing times and limit the number of disputes that enter the system improperly.
A central provision lowers the administrative fee from $115 to $15 per party per dispute.
The agencies indicated the reduction is intended to make the process more accessible while preserving the program’s self-sustaining funding structure.
Federal officials noted that the dispute resolution system has received far more cases than anticipated since its April 2022 launch, contributing to delays and operational bottlenecks.
To address those issues, the final rule expands opportunities for related claims to be combined into a single batched dispute while establishing limits on batch size to prevent excessive complexity.
The rule also requires insurers to use standardized claim coding when communicating with providers about out-of-network services.
Officials believe the requirement should allow providers to determine earlier whether a claim qualifies for arbitration, reducing confusion and the number of ineligible filings.
“Americans should never be blindsided by unexpected medical bills,” Health and Human Services Secretary Robert F. Kennedy Jr. said. “This rule cuts through bureaucratic delays, strengthens transparency between payers and providers, while continuing to protect patients from unnecessary financial stress.”
CMS Administrator Dr. Mehmet Oz characterized the changes as an effort to restore efficiency to a process strained by case volume.
“We are cutting fees, improving transparency, and restoring order to a system that was overwhelmed,” Oz said.
The rule also establishes the framework for a new centralized IDR Gateway platform that will be introduced in phases beginning in 2026.
According to regulators, the portal will eventually allow users to initiate disputes, track case status and manage filings through a single system. Future updates are expected to include direct negotiation tools and mandatory payer registration designed to help providers identify the correct parties before filing disputes.
The No Surprises Act, which took effect in 2022, protects patients from many unexpected out-of-network medical bills while requiring providers and insurers to resolve payment disagreements through a separate arbitration process.
The final rule is available at: https://www.cms.gov/files/document/federal-independent-dispute-resolution-operations-cms-9897-f.pdf
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