Executive Summary: Federal IDR Operations Final Rule
The Departments of Health and Human Services, Labor, and Treasury, along with the Office of Personnel Management, finalized updated rules for the Federal Independent Dispute Resolution (IDR) process under the No Surprises Act (NSA). The goal of the final rules, released May 28, 2026, is to increase efficiency in the IDR process with better communication between key stakeholders (payers, providers, and the certified IDR entities that facilitate the process).
Key Operational Changes
Improved Communication
- Payers must use specific Claim Adjustment Reason Codes (CARCs) and Remittance Advice Remark Codes (RARCs) on remittance advice to clearly indicate if a claim is subject to the NSA. This applies only to providers with non-network status with the payer.
- Payers must disclose additional clerical details to the provider at the time of the initial notice of payment or denial so that the provider has the necessary information to proceed with the IDR process, if applicable. This includes the legal business name and IDR registration number.
Open Negotiation Process
- Disputing parties must officially initiate the 30-business-day open negotiation period by submitting a formal notice through the Federal IDR portal. The goal of this measure is to create more accountability and push parties to engage in the open negotiation process prior to proceeding with IDR.
- The receiving party is now required to submit an official response notice by the 15th business day of the negotiation period.
Dispute Batching Limits
- Qualified items and services can be batched if they are: (1) for a single patient on the same/consecutive dates and billed on a single claim form; (2) for multiple patients billed under the same service code (e.g., CPT and HCPCS codes); anesthesiology, radiology, pathology, and laboratory service furnished to one or more patients under the same Category I CPT code section.
- All batched determinations are strictly capped at a maximum of 50 line items per dispute.
Eligibility Timelines
- Certified IDR entities are required to determine a dispute’s eligibility within 5 business days of being selected.
- Disputing parties have exactly 5 business days to respond to any requests for additional information needed to determine eligibility.
Fees and Extenuating Circumstances
- The non-refundable administrative fee is set at $15 per party, per dispute, regardless of the dispute amount or eligibility.
- Failure to pay administrative or entity fees invalidates a party’s offer, and unpaid fees are subject to federal debt collection laws.
Extenuating Circumstances
Deadlines may be extended for systemic delays, such as Federal IDR portal failures or unexpectedly high volumes of disputes.
New IDR Registry
- Payers are required to register with the Departments to obtain a unique IDR registration number.
- This registry will assist providers and IDR entities in correctly identifying plan types, enforcing jurisdictions, and resolving information-sharing bottlenecks.
Implementation Timeline
| Rule Provision | Effective / Applicability Date |
| New Administrative Fee ($15) | 5 business days after the publication of the final rules. |
| CARC and RARC Requirements | On the effective date of the final rules. |
| Batching Modifications | Applicable to open negotiations beginning 90 days after the effective date. |
| IDR Registry & Portal Updates | 90 business days after official guidance announces the functionality is live. |
Questions about the IDR process? We have a dedicated team at Kovo RCM that knows the ins and outs of IDR. We’re here to help your anesthesia, air ambulance, and ED practices thrive.