Departments correct No Surprises Act IDR rule as 50-line batching limits near for negotiations starting Nov. 1

The Departments of Health and Human Services, Labor and the Treasury, with the Office of Personnel Management, filed a correcting amendment on August 27 that fixes typographical errors and fills in omitted text in their June rule on the No Surprises Act’s federal independent dispute resolution (IDR) process [1]. The fixes reach back to August 3, the date the underlying rule took effect, and the Departments say they change no policy [1]. For out-of-network physicians, the date that matters is closer: under that rule, new batching limits govern disputes whose open negotiation period begins on or after November 1 [5].

What changed

The correcting amendment (CMS-9897-F2) walks through 35 corrections in the June 4 final rule, most of them cross-references, stray asterisks and wording in the Treasury, Labor and HHS versions of the regulation [1]. A few are omissions of real text. The Treasury and Labor versions left out the paragraphs stating that a certified IDR entity’s decision “Is binding upon the parties, in the absence of fraud or evidence of intentional misrepresentation of material facts” and “Is not subject to judicial review,” except in the cases described in section 10(a) of title 9 of the U.S. Code [1]. The Treasury version also lacked the rule’s definition of a downcode, meaning a plan’s change to a billed service code or modifier that is “associated with a lower qualifying payment amount” [1]. Because of the errors, the HHS version reprints the whole IDR process paragraph, 45 CFR 149.510(c) [1].

The Departments skipped notice and comment for the corrections, saying public comment would be “unnecessary” because the text reflects policies already proposed and finalized [1]. The amendment is effective on publication, scheduled for August 28, and applies beginning August 3 [1].

The rule underneath is the substantive change. Released May 28 and published June 4, it cuts the administrative fee each side pays per dispute from $115 to $15, caps batched disputes at 50 line items, requires plans to use standard remark codes on out-of-network remittances, and moves open negotiation into the federal IDR portal [2, 3, 4]. The process had received more than 5.1 million disputes as of January 31, 2026, after drawing 489,000 in its first year, 14 times what the Departments expected for a full year [2].

Who it affects

The IDR process settles out-of-network payment disputes between group health plans, health insurance issuers and Federal Employees Health Benefits carriers on one side, and nonparticipating providers, facilities and air ambulance providers on the other [2]. It covers emergency services and non-emergency services that out-of-network clinicians furnish during visits to in-network facilities, which include hospitals, hospital outpatient departments, critical access hospitals and ambulatory surgery centers [2].

Hospital-based specialties carry most of the volume. The batching rules give anesthesiology, radiology, pathology and laboratory services their own grouping option, by Category I CPT code range, “to address the unique circumstances of certain medical specialties and provider types” [3]. Ground ambulance services remain outside the surprise billing protections, the Departments said [2].

When do the new IDR batching rules start?

For disputes whose open negotiation period starts on or after November 1, 2026 [5]. The Departments announced on August 3 that the supporting function was available, which set the 90-day clock [5].

From that date, a certified IDR entity may consider up to 50 qualified items and services in one batched payment determination [1]. They must be billed under the same National Provider Identifier or Tax Identification Number and payable by the same plan or issuer; a third-party administrator serving several self-insured plans does not make them one payer [1]. The items must also fit one of three groupings [1]:

• A single patient encounter: one patient, one or more consecutive days, one claim form.
• The same service code: one or more patients, the same code or a comparable code in another coding system, such as CPT or HCPCS with modifiers.
• The same CPT range: for anesthesiology, radiology, pathology and laboratory services only, codes in the same Category I CPT code range named in guidance.

The services must still fall within one 30-business-day window from the first date of service [1]. The Departments also shortened the cooling-off period after a batched determination from 90 calendar days to 30 business days [2].

Other dates are already set. The $15 fee applies to disputes initiated since June 11 [5]. New disclosures that plans must send with an initial payment or denial, including the plan’s legal business name and a statement that providers must notify the Departments to start open negotiation, took effect August 3 [3, 5]. When a plan’s qualifying payment amount (QPA) rests on a downcoded claim, the plan must say which codes or modifiers it changed, why, and what the QPA would have been otherwise [2]. The QPA is generally a plan’s median contracted rate for a service, and the IDR entity must consider it in choosing between the two offers [1, 6].

What it means for your practice

Filing gets cheaper; batches get smaller. At $15 per party, the administrative fee is no longer the barrier it was for low-dollar claims [2]. But a group that batched large runs of claims will have to split them at 50 line items, and each batch carries its own certified IDR entity fee [1, 2].

Remittances will say more. Payers must use the No Surprises Act remark codes the Departments specified on July 17 for items and services furnished on or after January 1, 2027 [5]. Those codes tell you whether the payer considers a claim subject to the surprise billing and IDR rules, a threshold question for any dispute [3].

The portal steps are not live. The open negotiation notice through the portal, a required response by the 15th business day of negotiation, the 3-business-day initiation response and the payer registry all wait on IDR Gateway functions [2, 5]. The Departments expect to build them in spring 2027, starting with the registry, and each becomes required 90 calendar days after its notice [5]. Until then, the existing rules apply [2].

What did the Fifth Circuit decide about the QPA?

On August 11, the full Fifth Circuit ruled on how plans calculate the QPA, in a case brought by the Texas Medical Association, Tyler Regional Hospital and air ambulance companies [6]. The majority held that the 2021 rules unlawfully let insurers count “ghost rates,” fee schedule rates for services a provider never negotiated or performed, and unlawfully excluded bonus and incentive payments from the “total maximum payment” the statute names [6]. It upheld the exclusion of single-case agreements, which mostly affects air ambulances [6]. The court affirmed in part, reversed in part and remanded [6].

The majority pointed to IDR results as evidence that QPAs ran low: providers won more than 80% of arbitrations, and arbitrators chose an amount above the QPA in 85% [6]. The opinion sets no date for new QPA calculations. It quotes the district court’s observation that the agencies “can exercise their enforcement discretion to allow insurers to continue using their existing QPAs until new QPAs are calculated consistent with the Act” [6].

What to do now

1. Re-sort pending claims before November 1. Map which open negotiations will start on or after that date and group them under the 50-line cap and the three batching options [1, 5].
2. Check payer disclosures. For out-of-network claims paid or denied since August 3, confirm the payer sent its legal business name and the open negotiation statement, and for downcoded claims, the reason and the QPA before downcoding [2, 3, 5].
3. Ask your clearinghouse about remark codes. Your remittance processing should capture the No Surprises Act codes for services from January 1, 2027 [5].
4. Watch for Gateway notices. Each portal requirement starts 90 calendar days after its notice, and the Departments post those notices and email certified IDR entities and disputing parties on their IDR mailing list [5].
5. Track the QPA remand. If your offers lean on the QPA, the Fifth Circuit’s ruling could change that number for the plans you dispute with [6].

The policy fight

The administration presents the rule as a fix for a process that buckled under volume. “We are cutting fees, improving transparency, and restoring order to a system that was overwhelmed,” CMS Administrator Mehmet Oz said in May [4]. HHS Secretary Robert F. Kennedy Jr. said it “cuts through bureaucratic delays” [4].

Providers and payers split in the comment record, as the Departments summarized it. Many commenters opposed any line-item cap, describing it as “arbitrary and overly restrictive,” and a few warned that a cap would force providers with many small out-of-network claims into duplicate disputes [2]. Other commenters said a small number of providers may file ineligible disputes “to burden or disrupt the Federal IDR process,” and that paying only the standard fee was not enough of a deterrent [2]. The Departments had proposed a $150 fee and finalized $15, saying the lower figure would improve access for small and rural providers [2].

The Fifth Circuit split too. The majority rejected the agencies’ warning that vacatur would cause disruption: “The APA, however, does not embrace a too-big-to-vacate principle” [6]. Judge Haynes, joined by five colleagues, dissented on the ghost-rate and bonus questions, writing that the statute’s word “provided” “requires only that a given service be available” [6]. She agreed the case should be remanded rather than the rule vacated [6]. How the remand changes the QPA plans send with their payments is still open.