Regulatory Updates
Departments Issue Final Rule on Federal Independent Dispute Resolution Operations
Published May 28, 2026
The Departments of Health and Human Services, Labor, and Treasury (the Departments) and the Office of Personnel Management issued a final rule updating the standards for group health plans and health insurance issuers (payers); providers, facilities, and providers of air ambulance services (providers); and certified IDR entities related to the Federal Independent Dispute Resolution (IDR) process under the No Surprises Act.
The final rule will improve the functioning of the Federal IDR process by streamlining communication between payers, providers, and certified IDR entities and clarifying timelines and processes.
The rule requires plans and issuers to communicate information by using claim adjustment reason codes (CARCs) and remittance advice remark codes (RARCs), as specified in guidance, when providing any paper or electronic remittance advice (ERA) to an entity that does not have a contractual relationship with the plan or issuer.
The final rule finalizes:
- Amendments to certain requirements related to the open negotiation period preceding the Federal IDR process, the initiation of the Federal IDR process, the Federal IDR dispute eligibility review process, and the payment and collection of administrative fees and certified IDR entity fees,
- The definition of bundled payment arrangements, amends requirements related to batched items and services and amends the rules for extensions of timeframes due to extenuating circumstances, and
- Provisions that require plans and issuers to register in the Federal IDR portal.
The final rule is effective August 3, 2026.