NSA Answers
Each question has one canonical page: the direct answer first, then the detail, then the sources.
Only on narrow grounds. An IDR determination is binding and not subject to judicial review except in the four situations listed in Federal Arbitration Act section 10(a): fraud, corruption or undue means; evident partiality; arbitrator misconduct; or an entity exceeding its powers. In 2026, district courts dismissed six payer suits under that limit and two for lack of jurisdiction.
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Only on narrow grounds, and courts have so far declined to vacate awards in payer suits. The statute permits judicial review only on the Federal Arbitration Act's section 10(a) grounds, including fraud. In April 2026, courts dismissed Anthem v. HaloMD and Aetna v. Radiology Partners, finding the alleged fraud was known to the payers during IDR.
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No, not under the No Surprises Act itself. In Guardian Flight v. Health Care Service Corp. (June 12, 2025), the Fifth Circuit held the Act contains no private right of action to enforce an IDR award, and the Supreme Court denied certiorari on January 12, 2026. The court also rejected the providers' derivative ERISA and Texas quantum meruit claims.
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It depends on the court, but both appellate courts to rule say no. The Fifth Circuit (June 2025) and Second Circuit (September 17, 2026) hold the No Surprises Act creates no private right of action to enforce IDR awards. The Second Circuit left open whether suits to confirm awards are barred. The District of Maryland found a narrow implied right.
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Yes. Multiple qualified IDR items and services can be decided in one batched determination. Under the 2026 Federal IDR Operations rule, for disputes whose open negotiation period begins on or after November 1, 2026, a batch may hold up to 50 line items and must fit one of three categories the rule defines.
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Where they apply, yes. The No Surprises Act defers to a specified state law that sets the out-of-network payment amount for a plan the state can regulate, and to All-Payer Model Agreements. In those cases the state method, not federal IDR, sets payment. A state law reaches a plan only to the extent ERISA preemption allows.
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Thirty calendar days. Federal regulations require the plan or issuer to pay the selected offer, less the initial payment and any patient cost sharing, directly to the provider within 30 calendar days after the certified IDR entity's determination. If the selected offer is below what was already paid, the provider owes the plan the difference on the same timeline.
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More than 5.1 million disputes had been submitted to the federal IDR process as of January 31, 2026, the Departments reported in the Federal IDR Operations rule, citing CMS data. CMS reports 1,372,563 disputes initiated from July 1 to December 31, 2025 alone. Certified IDR entities found 355,804 disputes ineligible from April 2022 through December 2024.
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Providers win most federal IDR payment determinations. CMS reports that providers, facilities and air ambulance providers prevailed in about 85% of determinations from July 1 to December 31, 2025, and about 88% from January 1 to June 30, 2025. In the second half of 2025, the prevailing offer exceeded the QPA in about 87% of determinations.
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For disputes initiated on or after June 11, 2026, the federal administrative fee is $15 per party per dispute, down from $115, and it is non-refundable. Certified IDR entity fees range from $200 to $840 for single determinations and $268 to $1,173 for batched determinations. The party whose offer is not selected pays the entity fee.
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On September 17, 2026, the Second Circuit held that the No Surprises Act does not provide a private right of action to enforce IDR payment awards, and affirmed dismissal of a provider's suit over more than $3 million in awards against Cigna. It joined the Fifth Circuit, noting the Act cross-references FAA vacatur but not confirmation.
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The Texas Medical Association v. HHS cases struck down federal rules that favored the QPA in IDR. Courts vacated the QPA presumption in 2022, later QPA-weighting rules in 2023 (affirmed in 2024), and the 2023 fee increase and batching rules. In August 2026 the en banc Fifth Circuit held that QPAs cannot include ghost rates.
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An IDR underpayment audit compares each award with what federal rules require the plan to pay: the selected offer, less the initial payment and patient cost sharing, paid within 30 calendar days of the determination. It can also test whether the initial payment or denial arrived within 30 calendar days of the bill and carried the required QPA disclosures.
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Verdict Consulting Group is a data and analytics consultancy for No Surprises Act and health care litigation. We audit IDR underpayments, build expert-ready analyses and damages models for counsel, run eligibility forensics, and track award payment claim by claim for provider groups. We are not a law firm and do not provide legal advice.
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The statute relies mainly on federal enforcement. Unpaid awards can be reported to the No Surprises Help Desk, and under 42 U.S.C. 300gg-22 HHS may impose civil money penalties of up to $100 per day for each affected individual. Whether a provider can also sue to collect depends on the court: the Fifth and Second Circuits say no.
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The 2026 Federal IDR Operations rule requires plans and issuers to use specified claim adjustment reason codes (CARCs) and remittance advice remark codes (RARCs) on remittance advice to out-of-network providers, showing whether a claim is subject to surprise-billing protections and federal IDR. Under July 17, 2026 guidance, it applies to services furnished from January 1, 2027.
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The cooling-off period is the 90 calendar days after an IDR payment determination during which the initiating party cannot file a new dispute against the same party over the same or a similar item or service. Claims whose open negotiation ends in that window can be submitted within 30 business days after it closes.
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The IDR Gateway is the Departments' new secure, centralized platform for the federal IDR process, replacing single-use web forms in late 2026. Users can start and respond to disputes, track dispute status and view organization dashboards. CMS says the web forms will no longer be available outside the Gateway after January 15, 2027, with one exception.
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The Federal Independent Dispute Resolution Operations rule is a final rule published at 91 FR 33900 on June 4, 2026, effective August 3, 2026, and corrected at 91 FR 55462 on August 28, 2026. It revises how No Surprises Act IDR runs, covering CARC/RARC codes, open negotiation, batching, a $15 administrative fee and plan registration.
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The open negotiation period is a required 30-business-day window in which an out-of-network provider and a health plan try to agree on a payment amount before federal IDR. Either party may start it within 30 business days of the initial payment or denial. If no agreement is reached, IDR must be initiated within the following 4 business days.
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The qualifying payment amount (QPA) is a plan's median contracted rate for the same or a similar service, by provider specialty and geographic region, as of January 31, 2019, adjusted each year for inflation. Certified IDR entities must consider it in every payment determination. In August 2026 the en banc Fifth Circuit held that non-negotiated ghost rates cannot be counted.
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A dispute is ineligible if it does not involve a qualified IDR item or service, for example because a specified state law, an All-Payer Model Agreement, Medicare or Medicaid governs payment, or if open negotiation, timing, batching or cooling-off rules were not met. Certified IDR entities found 355,804 disputes ineligible from April 15, 2022 to December 31, 2024.
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