No Surprises Act update
The federal IDR administrative fee dropped from $115 to $15 per party in 2026. Small out of network claims that were not worth disputing before may now be worth filing.
Updated October 31, 2026
For federal IDR disputes started on or after June 11, 2026, the administrative fee is $15 per party per dispute, down from $115. The change comes from the Federal IDR Operations Final Rule, published June 4, 2026 and effective August 3, 2026. Disputes started from January 22, 2024 through June 10, 2026 keep the $115 fee. The separate certified IDR entity fee is still paid by the side that does not prevail.
The main changes and when each one applies.
| Change | What it means for providers | Applies from |
|---|---|---|
| Administrative fee cut | $15 per party instead of $115 | Disputes started on or after June 11, 2026 |
| Entity fee timing and refunds | Paid after eligibility is confirmed; losing side pays; half returned if settled after eligibility | Disputes started on or after August 3, 2026 |
| New batching test | Items for treatment of a similar condition can be grouped, up to 50 per batch; anesthesiology, radiology, pathology and lab can batch by CPT code range | Open negotiation periods starting on or after November 1, 2026 |
| Remittance codes | Plans must use standard codes showing whether a claim is subject to the No Surprises Act, plus deadlines and the plan IDR registration number | Under the final rule |
| Plan registry | Plans and issuers must register and get an IDR registration number | 90 business days after federal guidance |
| Portal based notices | Open negotiation and IDR notices move to the federal IDR portal; the other side must answer by business day 15 | 90 days after federal portal guidance |
Summary based on the final rule as described by Holland and Hart and Goodwin. Confirm current dates with CMS before filing.
At $115 per party, many practices skipped disputes where the gap between the payment and a fair rate was small. At $15, the math changes. Review these groups first:
The entity fee still matters, because the losing side pays it. A dispute is worth filing when the evidence supports a higher offer, not just because the filing fee is low.
Recent federal data shows how heavily providers use IDR and how often they win.
1,186,812
Federal IDR disputes started in the first half of 2025
88%
Payment decisions where the provider or facility prevailed
45%
Share of decisions involving emergency department services
CMS Federal IDR supplemental background, January to June 2025. Source
The steps stay familiar, but the details and the portal are changing. Official guidance is on the CMS No Surprises Act site.
Check whether the plan marked the claim as subject to the No Surprises Act.
Send the notice with all required details and wait the 30 business days.
File within 4 business days after negotiation ends, with the eligibility attestation.
Pay the $15 administrative fee and the entity fee by the offer due date.
Send a data backed offer within 10 business days after the entity is selected.
Expect a decision within 30 business days after selection, then follow payment.
Send us your last 90 days of underpaid out of network claims. We will show which ones are still inside the deadline and worth taking to IDR at the new fee.
Tell us about your practice and a billing specialist will contact you.
