The bipartisan No Surprises Act (NSA) has protected an estimated 50 million Americans from surprise medical bills and lowered their out-of-pocket medical expenses. Today, with patients removed from the middle, healthcare providers and payers depend on the Independent Dispute Resolution (IDR) process to settle and/or arbitrate payment disputes.
Program Improvements are Pending
A regulatory update to the five-year old program is pending. The IDR Proposed Operations Rule has received extensive stakeholder input on how to improve the system and reduce operational friction points. It proposes critically needed upgrades regarding information sharing, and how disputes are initiated, documented, batched, paid, and administered. Parties to the process will need to update their workflows and approach to the IDR process. Historically high-performing program users have already started.
As a leading IDR entity, FHAS knows the goal is to make the program more consistent, transparent, and usable—because when the process works better, the law works better.
We encourage parties to view the advent of new regulations as an opportunity to improve reimbursement outcomes and minimize delays – and we are prepared to help. FHAS is the first and the only IDRE to earn the Utilization Review Accreditation Commission (URAC) IDR designation. Trust us to serve as a knowledgeable, impartial guide through process.
Begin Preparing for New Regulations Today
We encourage parties to focus on the following key changes.
Turn Ineligible Rulings into a Quality Engine
According to the most recently reported federal data, 17% of all IDR cases are determined ineligible at submission, and non-initiating parties object to roughly 40% of claims on ineligibility grounds. High performers treat these determinations not as failures but as actionable data — using specific root causes to improve intake protocols, staff training, and future submissions.
Improved Early Communications
The proposed rule strengthens early communication requirements, including updated CARC/RARC codes and new IDR Registration numbers on EOBs, giving providers better information to assess eligibility before submitting a claim. Accurate upfront communication is a shared goal — and a practical way to reduce the ineligible filings that create friction for all parties.
Strengthen Open Negotiation Before It Becomes an Eligibility Problem
The imminent IDR Gateway moves open negotiation from error-prone email chains into a centralized portal with verified timestamps. Preparing Gateway-compatible documentation now — before the system goes live — helps parties avoid the incomplete or invalid negotiation records that have been a consistent source of downstream problems.
Get Batching Right Before Submitting, Not After Rejection
Batching errors — grouping claims outside the 30-day window, mixing providers or payers, and misapplying an IDRE’s interim methodology — remain among the most common and avoidable sources of ineligibility. The proposed rule standardizes the process with a hard cap of 25 line items per batch and adds specific guidance for radiology and anesthesiology.
A Word on the Cooling Off Period
Under the proposed rule, the cooling off period between determinations involving the same service code, providers, or payers would shrink from 90 days to between 1 and 30 days. This welcome change reduces scheduling confusion and gives parties meaningfully more flexibility in managing their IDR caseloads.
Expect More from Your IDRE
Finally, as the IDR program evolves, so should your expectations of the IDRE you select. As you make this strategic selection, look for data-driven insights and value-added services that can make your IDR program more effective. Require deep account services support, expert published guidance, willingness to consult proactively, and preparedness to help you implement the Proposed Rule’s requirements. Expect third-party quality validation like URAC’s IDR designation.
As true stewards of the No Surprises Act, FHAS is committed to the success of the federal IDR program and to the seamless implementation of the new regulations that will govern the program. We look forward to working with parties to ensure the process works as intended for all stakeholders.
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The information contained in this content piece is for general informational purposes only. While we strive to ensure the accuracy and completeness of the information presented, we make no representations or warranties of any kind, express or implied, about the accuracy, reliability, suitability, or availability with respect to the content or the information, products, services, or related graphics contained in the content piece for any purpose. Any reliance you place on such information is therefore strictly at your own risk. The content of this page is subject to change without notice. The information provided in this document does not constitute legal or other professional advice, and is non-binding upon FHAS and any federal government agencies.
