Federal Independent Dispute Resolution Operations
AI-generated summary for informational purposes only. Not legal advice. See the original source for the authoritative text.
This rule updates how health plans, insurers, providers, and dispute resolution entities handle surprise billing disputes under the No Surprises Act. It adds clearer disclosure duties when a plan or insurer makes an initial payment or denies payment for covered out-of-network services. It also standardizes the use of payment and denial codes, changes parts of the negotiation and dispute filing process, clarifies bundled and batched claims, adjusts fee payment rules, and requires plans and insurers to register in the Federal IDR portal. Health plans, insurers, providers, and billing teams will need to update claims, remittance, and dispute workflows before the rule takes effect on August 3, 2026.
AI-generated summary. May contain errors. Refer to official sources for legal decisions.
Key Changes
- Requires health plans and insurers to provide more information with initial payments or payment denials for covered surprise billing items and services
- Requires standardized claim adjustment and remittance codes when communicating with out-of-network entities
- Updates rules for open negotiation, IDR initiation, eligibility review, bundled payments, batched claims, deadline extensions, fees, and Federal IDR portal registration
Obligations
What this law requires
Group health plans and health insurance issuers must include required disclosures with the initial payment or notice of denial of payment for items and services subject to the No Surprises Act surprise billing protections.
Plans and issuers must use specified claim adjustment reason codes and remittance advice remark codes when providing paper or electronic remittance advice to an out-of-network entity that does not have a contractual relationship with the plan or issuer.
Plans, issuers, providers, and billing teams must update open negotiation and Federal IDR initiation workflows to follow the amended process requirements for surprise billing disputes.
Plans and issuers must register in the Federal IDR portal as required by the final rule.
Parties using the Federal IDR process must comply with amended requirements for payment and collection of administrative fees and certified IDR entity fees.