The federal No Surprises Act has become a flashpoint for physician groups and payers alike as the law’s independent dispute resolution process draws criticism due to costly inefficiencies and other process issues.
Here are eight updates on the NSA and plans for its reform:
1. HHS, CMS, the Labor Department and the Treasury Department finalized a rule May 28 overhauling the federal IDR process under the No Surprises Act. Under the new policies, the administrative fee per party per dispute will drop from $115 to $15, a reduction of more than 85%. The change directly affects the economics of disputing smaller claims, an issue that has frustrated specialty practices since the IDR process launched in April 2022.
2. Separately, if either party fails to pay its administrative or certified IDR entity fee by the time its offer is due, that offer will not be considered received, though the financial obligation remains.
3. The rule lays the groundwork for the IDR Gateway, a single platform rolling out in phases this year where users can initiate disputes, track the status of a case and manage activity. The gateway replaces the current single-use web form system that generated a backlog of 90,000 claims within months of the process launching in 2022. Additional features, including in-portal negotiation tools, are expected to roll out over time.
4. The rule broadens the circumstances under which multiple claims can be grouped into a single “batched” dispute, which reduces costs for both parties. Claims can now be batched when they involve a single patient on the same or consecutive dates of service billed together; when claims share the same service code; or when anesthesiology, radiology, pathology and laboratory claims fall within the same CPT code section. At the same time, batched disputes are now capped at 50 line items to allow certified IDR entities to process cases in a timely and financially sustainable way.
5. The rule formalizes the 30-business-day open negotiation period that precedes IDR filing. Going forward, parties must initiate that period through the federal portal, and the opposing party must submit a formal response by the 15th business day. Certified IDR entities must now complete eligibility determinations within five business days of being selected. The changes come after federal officials found that many parties were bypassing meaningful negotiation, with some open negotiation notices bundling thousands of items and services.
6. A Texas federal court has dismissed a Blue Cross and Blue Shield of Texas lawsuit against independent dispute resolution company HaloMD May 27. The lawsuit, filed in 2025, alleged HaloMD, which focuses on the provider side of IDR disputes, formed a scheme to exploit the arbitration process. BCBS Texas, under Health Care Service Corp., alleged the medical billing company submitted ineligible claims for resolution under the NSA and Texas state law.
7. Fort Worth, Texas-based Radiology Associates of North Texas projected more than $51 million in avoidable administrative costs tied to current No Surprises Act arbitration batching rules and unpaid IDR awards.
8. The American Medical Association, 50 state medical societies and 46 healthcare organizations urged congressional leaders to support bipartisan legislation aimed at strengthening enforcement of the No Surprises Act, according to a letter released May 11. The legislation — H.R. 4710/S. 2420 — would authorize penalties for parties that fail to comply with statutory payment timelines following final Independent Dispute Resolution determinations. The bill also would give federal regulators explicit authority to enforce IDR decisions.
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