Employers frustrated by the rising costs of out-of-network claims covered by the No Surprises Act may have some relief on the horizon under final regulations for the Independent Dispute Resolution (IDR) system published June 4, 2026, in the Federal Register.

• Starting June 11, 2026, the fee for IDR disputes will be lowered from $115 to $15, making the process more accessible for smaller disputes but potentially increasing the system backlog.
• Health plans and insurers must register in a new IDR registry to help providers correctly identify payors, potentially reducing ineligible or misdirected disputes.
• The open negotiation period will be managed through the federal IDR portal using standardized forms, with a fifteen-business-day response window, aiming to reduce disputes that are ineligible for IDR.
• An IDR entity must determine dispute eligibility within five business days, and payment determinations must be made within thirty business days, with binding decisions based on submitted payment offers.

Recent research has found that many claims that wind up in the IDR arbitration system generate awards for providers that are several times higher than the in-network median amount paid, or qualifying payment amount (QPA) for the relevant service in the relevant market. Those amounts are growing, and providers are winning nearly 90 percent of those disputes, which involve either emergency room charges or, primarily, out-of-network specialists—such as anesthesiologists,...

Read Full Story: https://news.google.com/rss/articles/CBMisAFBVV95cUxPNmhMRXQxRnkxUnQzdGZENE9U...