WASHINGTON, D.C. — Health care providers and insurance companies will pay significantly lower fees to resolve certain payment disputes under a new federal rule that officials say is designed to reduce delays, improve transparency, and strengthen protections against surprise medical bills.
What This Means for You
- Patients remain protected from many surprise medical bills under the No Surprises Act.
- Administrative fees for payment disputes will drop from $115 to $15 per party, potentially lowering costs within the system.
- A new federal dispute-management portal is planned for 2026, allowing providers and insurers to track cases and manage disputes in one location.
The rule, finalized by the U.S. Department of Health and Human Services, the Department of Labor, the Department of the Treasury, and the Office of Personnel Management, updates the Federal Independent Dispute Resolution process. The process serves as an arbitration system that helps health care providers and insurers resolve disagreements over payments for certain out-of-network medical services.
Federal officials said the changes are intended to address growing backlogs after the dispute system received more than 5 million cases since launching in April 2022, far exceeding original expectations.
Fee Reduction Aims to Lower Barriers
One of the most significant changes is a reduction in the administrative fee charged to participants in the dispute process.
Under the finalized rule, the fee will decrease from $115 to $15 per party for each dispute, a reduction of more than 85%.
Federal officials said the lower fee is intended to make participation more affordable while maintaining a self-sustaining dispute resolution program.
HHS Secretary Robert F. Kennedy Jr. said the rule is designed to reduce delays and improve transparency.
“Americans should never be blindsided by unexpected medical bills,” Kennedy said. “This rule cuts through bureaucratic delays, strengthens transparency between payers and providers, while continuing to protect patients from unnecessary financial stress.”
Changes Intended to Reduce Backlogs
The rule also expands opportunities for multiple related claims to be combined into a single dispute, a practice known as batching.
Federal officials said allowing more claims to be grouped together could reduce costs and speed decisions. At the same time, the rule establishes limits on the number of claims that can be included in a single batched dispute to prevent cases from becoming overly complex.
Officials said these changes are intended to reduce the number of ineligible claims entering the system and improve overall efficiency.
New Communication Requirements
The rule requires insurers, commonly referred to as payers in federal regulations, to use standardized claim codes when communicating with providers about out-of-network services.
Federal officials said the requirement will help providers determine earlier whether a claim qualifies for the dispute resolution process, reducing confusion and preventing disputes that do not meet eligibility requirements.
“This rule makes significant improvements to the arbitration,” said Mehmet Oz, administrator of the Centers for Medicare & Medicaid Services.
“We are cutting fees, improving transparency, and restoring order to a system that was overwhelmed,” Oz said.
New IDR Gateway Planned for 2026
The rule also establishes the framework for a new Federal Independent Dispute Resolution Gateway, a centralized online platform that federal officials plan to launch in phases beginning in 2026.
According to the agencies, the portal will allow users to initiate disputes, track case status, and manage dispute-related activity in a single location.
Future phases are expected to require insurer registration within the system, making it easier for providers to identify the correct party involved in a dispute and reduce administrative errors. Additional features, including in-portal negotiations, are expected to be added over time.
Federal Officials Cite No Surprises Act Goals
The No Surprises Act, which took effect in 2022, protects patients from many unexpected medical bills that can occur when they receive emergency care or treatment from out-of-network providers at in-network facilities.
Acting Labor Secretary Keith Sonderling said the administration believes the changes will help the dispute resolution system operate more efficiently.
“By improving transparency, streamlining dispute review, and ensuring consistent communication standards, we are helping all parties obtain timely, fair payment determinations while reducing administrative burdens,” Sonderling said.
Next Steps
The final rule is now in place, with implementation of some operational changes expected to occur over time. Federal officials said development of the new IDR Gateway will begin rolling out in phases starting in 2026.
The full rule is available from the Centers for Medicare & Medicaid Services: Federal Independent Dispute Resolution Final Rule.
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