Federal Register #2026-11140

Final Rule: Federal Independent Dispute Resolution Process Requirements under the No Surprises Act

This final rule, issued by the Departments of Treasury, Labor, Health and Human Services, and the Office of Personnel Management, establishes new requirements for the Federal Independent Dispute Resolution (IDR) process under the No Surprises Act. - Government Buyer: - Departments of Treasury, Labor, Health and Human Services, and Office of Personnel Management (Federal Independent Dispute Resolution Operations) - No Original Equipment Manufacturers (OEMs) or commercial vendors are involved, as this is a regulatory action. - Key Provisions: - Defines bundled payment arrangements for IDR disputes - Mandates use of standardized claim adjustment reason codes (CARCs) and remittance advice remark codes (RARCs) for communication between health plans/issuers and providers/entities without a contractual relationship - Requires group health plans, health insurance issuers, and FEHB carriers to register in the Federal IDR portal with plan identification and contact information - Establishes detailed open negotiation and IDR initiation procedures, including use of the Federal IDR portal - Sets criteria for batching up to 50 related items/services in a single dispute (same provider, same plan, related treatment, furnished within 30 business days) - Reduces the administrative fee to $15 per party per dispute for disputes initiated on or after the specified date - Notable Requirements: - Standardized communication protocols for remittance advice - Expanded disclosure obligations for health plans and issuers - Enhanced transparency, efficiency, and accessibility in the IDR process - No products or services are being procured; this is a regulatory and operational rulemaking

Description

This final rule finalizes provisions related to the No Surprises Act, including disclosure requirements, communication protocols, dispute resolution processes, and registration in the Federal IDR portal. It sets forth rules for the Federal independent dispute resolution process established by the Consolidated Appropriations Act, 2021. The rules require plans and issuers to use claim adjustment reason codes (CARCs) and remittance advice remark codes (RARCs) for communication and finalize amendments related to negotiation periods, dispute eligibility, and fee payments. The rules are effective on August 3, 2026.

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