What is the open negotiation period in the No Surprises Act?
Verdict Consulting Group Research · Updated
Answer
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.
Detail
Key timeframes
| Step | Timeframe |
|---|---|
| Start open negotiation | Within 30 business days of receiving the initial payment or notice of denial |
| Open negotiation period | 30 business days from the open negotiation notice |
| Initiate federal IDR | During the 4 business days after open negotiation ends |
| Response notice (2026 rule) | By the 15th business day of the period |
What the 2026 rule changes
The Federal Independent Dispute Resolution Operations rule (91 FR 33900) keeps the 30-business-day length. It adds required content for the open negotiation notice, requires notices to go through the federal IDR system, and creates an open negotiation response notice due by the 15th business day.
According to CMS's August 7, 2026 implementation guide, these open negotiation changes apply to disputes whose open negotiation periods begin 90 calendar days after the Departments announce that the supporting IDR Gateway functionality is available. Until then, the existing requirements continue to apply.
Read the analysis
Sources
- Electronic Code of Federal Regulations — 45 CFR 149.510 — Independent dispute resolution process ()
- Centers for Medicare & Medicaid Services — About Independent Dispute Resolution ()
- Centers for Medicare & Medicaid Services — Federal IDR Operations Final Rules Implementation Timeline Guide ()
General information only, not legal advice. Verdict Consulting Group is not a law firm.