Logo
↩ Return to Blog
Anesthesia
June 8, 2026
IDR Final Rule: Significant Changes on the Way

IDR Final Rule: Significant Changes on the Way

Late last month, the Centers for Medicare and Medicaid Services (CMS) published a final rule that pertains to the primary reimbursement mediation mechanism as mandated in the federal No Surprises Act (NSA).  The new rule will directly impact how anesthesia providers function and fare under that law.  The following CMS press release excerpt provides a hint at what providers can expect:

IDR Final Rule: Significant Changes on the Way

Share

Major reforms were finalized today to strengthen the No Surprises Act by making the Federal Independent Dispute Resolution (IDR) process more efficient and transparent, while also saving money for millions of Americans.  The final rule improves the process used to resolve out-of-network payment disputes between providers and payers—cutting administrative costs and improving how disputes are handled.

Those are the broad strokes.  Below are the specifics.

The IDR final rule contains over 600 pages and will become effective 60 days after it is published in the Federal Register.  However, much of its provisions will not be effective until 90 days after the U.S. Department of Health and Human Services (HHS) publishes guidance stating that it has implemented the resources to operationalize these provisions.  The following will act to summarize some of the highlights found in the final rule.

  1. New EOB Codes.  One of the primary deficiencies of the original NSA final rule was the lack of specific claims adjustment reason codes and remittance advice remark codes on the explanation of benefits (EOB) or remittance advice forms to identify whether a claim is, or is not, subject to the federal IDR process.  This has been the source of a lot of confusion and difficulties for both billers and providers alike.  These challenges should be resolved with the implementation of this new rule.  Out-of-network payers will now have to include specific claims adjustment reason codes (CARCs) and remittance advice remark codes (RARCs) on the EOBs.  These codes will identify whether the claim is, or is not, subject to the federal IDR process.  The purpose of this change is to reduce the number of inapplicable claims that are erroneously submitted to the IDR process and thus reduce the burden on IDR entities.
  1. Self-Insured Plans.  If the health plan is self-insured, the payer must identify its legal name.
  1.  Negotiation Notices.  There is currently a 30-business-day period for the parties to negotiate before submitting a claim to the IDR process.  However, providers have been submitting claims to the IDR process without negotiating.  To rectify that, either the insurer or the provider may, during the 30-business-day period (beginning on the date the provider receives the EOB), initiate a 30-business-day negotiation period by sending a written open negotiation notice to the other party and to HHS via the federal IDR portal.  The party receiving the open negotiation notice must send (within 15 business days of that notice being sent) an open negotiation response notice through the same portal.  Each of these notices is required to contain 10 or more fields of information specified in the regulations.  Once again, these notices are designed to weed out claims that are not subject to the IDR process.
  1.  Batching.  An IDR entity may rule on 50 line items in a batched set of claims.  For anesthesiology, there is a specific rule that those claims can be batched if they are “billed under service codes belonging to the same Category I CPT code range, as specified in guidance published by the Secretary.”  We believe this means all anesthesia codes, i.e., 00100-01999, could be batched together (subject to the 50 line item limit), but we will need to wait for further guidance from HHS.
  1.  IDR Verification of Eligibility.  To expedite claims eligibility review, IDR entities must, under the new final rule, determine whether a claim is eligible for the IDR process within five business days of being selected as the IDR entity.  If the IDR entity requires additional information, it will notify the parties, who must submit that additional information within another five business days.
  1.  Fees Reduced.  Both parties to the IDR process must pay nonrefundable administrative fees.  Those fees are being reduced from $115 to $15 per party, per dispute.  The reduced administrative fee of $15 will begin five business days after publication of the final rule in the Federal Register.
  1.  Plan Registration Numbers.  Due to the number of different plans being administered by payers, each plan must now register with HHS and receive a registration number, which can be accessed through the IDR portal.  This will allow providers to know which specific plan is involved.

We will provide further information on the IDR final rule as it becomes available.  To review the CMS fact sheet on the final rule, you can click here: https://www.cms.gov/newsroom/fact-sheets/federal-independent-dispute-resolution-operations-final-rule.