The U.S. Departments of Health and Human Services, Labor, and Treasury, along with the Office of Personnel Management, released a Final Rule on May 28, 2026, making significant changes to how billing disputes between out-of-network providers and insurance payers are handled under the No Surprises Act (NSA). The rule focuses on improving communication, speeding up the dispute process, and making timelines clearer for everyone involved.

Communication and Open Negotiation

One of the key changes in this rule is how payers communicate with out-of-network providers. Payers are now required to use specific Claim Adjustment Reason Codes (CARCs) and Remittance Advice Remark Codes (RARCs) on all payment statements sent to out-of-network providers. These codes must clearly indicate whether a claim falls under the NSA's surprise billing protections. Along with initial payments or denials, payers must also include their legal business name, plan sponsor name where applicable, and their IDR registration number.

The open negotiation process has also been restructured. Providers must now submit their negotiation notices through the Federal IDR portal. The other party then has until the 15th business day of the 30-business-day negotiation window to respond. Both the initial notice and the response must include more detailed information than before, such as eligibility documentation and enough detail to clearly identify who is involved and what is being disputed.

Batching

The rule also makes it easier for providers to group multiple claims into one dispute, a process called batching. Under the updated rules, providers can now batch together services provided to a single patient during one visit, claims billed under the same service code across different patients, and for specialties like anesthesiology, radiology, pathology, and lab services, claims that fall within the same Category I CPT code range. However, batched disputes cannot exceed 50 line items.

Eligibility, Fees, and a New IDR Registry

Once an IDR entity is selected, it now has five business days to determine whether a dispute is eligible and notify both parties and the Departments. If a party does not respond to a request for additional information within five business days, the determination moves forward without their input.

The administrative fee has been cut to $15 per party per dispute. If either party fails to pay their fees by the time offers are due, their offer is treated as not received, which effectively means they lose the dispute by default. The Departments can also pursue unpaid fees through federal debt collection processes.

To help providers identify the right payer when filing a dispute, a new Federal IDR registry is being created. Payers must register and provide details about their plan type, state law status, and contact information. Providers will be able to look up payer registration numbers through the Federal IDR portal.

When Do These Changes Take Effect

Most of the procedural changes in this rule, including the updated negotiation, batching, and eligibility requirements, will take effect 90 days after the Departments announce that the necessary portal features are ready. The reduced $15 administrative fee already applies to disputes filed on or after June 11, 2026. The new IDR registry provisions will kick in 90 business days after the registry functionality is announced as available.

Enforcement Concerns Remain

Despite requests from commenters to add stronger penalties for payers who ignore IDR outcomes, the Departments decided not to create any new enforcement mechanisms. They are sticking with the enforcement tools already available under existing law and say they will monitor for noncompliance based on available staff resources.

This is a real concern for providers. There is currently no strong mechanism to force payers to actually pay after an IDR decision goes in a provider's favor. Providers who win disputes may still face delays or outright refusal to pay. Experts are advising providers to keep detailed records, use existing regulatory channels to escalate issues, and consider legal remedies where necessary.

What Providers Should Do Now

Given these changes, providers are advised to update their internal workflows to match the new portal-based submission requirements. Internal deadline tracking systems should be set up to monitor the 30-business-day negotiation period and the 15-business-day payer response deadline. Revenue cycle staff should be trained to identify and flag CARC and RARC codes on payment statements, and any missing codes should be documented right away.

Providers should also revisit their dispute strategies to take advantage of the expanded batching rules while staying within the 50-item cap. Using the new IDR registry to confirm payer information before filing will help avoid rejected or delayed disputes. Strong documentation from the start of each dispute will be essential, and providers should keep a running log of any payer failures to comply so that issues can be escalated when needed.