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★Physician Organizations Oppose Legislation that Gives Health Insurers Unilateral Control Over Out-of-Network Payments. ASA, ACEP and ACR warn legislation is premature as federal reforms remain unimplemented and Congress considers bipartisan solutions to strengthen No Surprises Act. Read the details at Physician Organizations Oppose Legislation That Gives Health Insurers Unilateral Control Over Out-of-Network Payments.
★ASA Monitor Highlights ASA's No Surprises Act Leadership. The No Surprises Act continues to shape physician payment and independent dispute resolution (IDR) processes. In a recent ASA Monitor article, ASA leaders discuss the specialty's advocacy efforts, ongoing regulatory developments, and the importance of protecting fair physician payment while preserving patient access to care. Read the article.
★New findings reveal how insurers may leverage low initial payments, flawed QPAs, and impractical contract terms to force physicians into the IDR process to secure appropriate payment. The analysis of CMS data was submitted to Congress by ASA, ACEP, and ACR.
Access the press release and full report to learn more.
★CMS Releases New IDR Gateway Administrator User Guide. Organizations submitting to the Federal Independent Dispute Resolution (IDR) process now have a new resource to support implementation efforts. CMS released the Independent Dispute Resolution (IDR) Gateway Administrator User Guide, providing information for designated administrators responsible for managing organizational access to the IDR Gateway. The guide is intended to help organizations navigate user account management and other administrative functions within the system. ASA members and stakeholders involved in the IDR process are encouraged to review the guide and share it with team members responsible for dispute resolution operations.
View the resource: Independent Dispute Resolution (IDR) Gateway Administrator User Guide
★CMS Updates Federal Independent Dispute Resolution (IDR) Batching Rules Effective November 1, 2026
The Centers for Medicare & Medicaid Services (CMS) announced that the Federal Independent Dispute Resolution (IDR) portal will implement new functionality and requirements for batched IDR disputes beginning November 1, 2026, consistent with the Federal IDR Operations Final Rules. Key changes include:
CMS notes that all batching provisions under the final rule will apply to disputes with open negotiation periods beginning on or after November 1, 2026.
Resources
★Federal agencies issue No Surprises Act guidance requiring plans to use new remittance codes. (July 17, 2026). As part of the implementation of the No Surprises Operations Rule, the agencies have issued guidance that identifies standardized remittance advice remark codes (CRAC and RARC codes) that will tell out-of-network clinicians whether a claim is eligible for the Federal IDR process or a state IDR process. The requirements, a long-requested change sought by ASA, apply to services furnished on or after January 1, 2027, and should improve transparency and reduce disputes over IDR eligibility. See details at Guidance on Required Remittance Advice Remark Codes Related to the No Surprises Act
★Federal judge dismisses Elevance/Blue Cross lawsuit challenging No Surprises Act IDR awards. (July 15, 2026). A federal court dismissed claims against HaloMD and two Georgia physician groups, concluding that the requested relief would require the court to second-guess certified IDR determinations. The ruling is HaloMD's third recent dismissal in insurer filed No Surprises Act litigation; Elevance has said it plans to appeal. Key quote from the ruling: “Plaintiff engages in a consistent practice of submitting lowball offers to out-of-network providers in an effort to maximize its profits.”
★Independent Dispute Resolution (IDR) Operations Final Rule Issued. On May 27, 2026, the federal government published the No Surprises Act IDR Operations Rule, introducing long-awaited improvements to the IDR process. ASA engaged extensively with federal agencies and the Office of Management and Budget following the 2023 proposed rule, and several of its recommendations were incorporated. Key changes include expanded batching (up to 50 claims by CPT body-part range), enhanced payer transparency through required CARCs/RARCs, establishment of a federal IDR registry, and a reduction in the cooling-off period for batched claims from 90 to 30 days. The rule also strengthens open negotiation requirements, lowers the administrative fee from $115 to $15, and allows certain anesthesia add-on codes (99100, 99116, 99135, 99140) to be batched with primary anesthesia services.
While these updates represent meaningful progress in improving IDR usability and addressing certain payer practices, the rule fails to address one of the most significant and ongoing challenges: payer noncompliance with timely payment following IDR determinations. Without clear enforcement mechanisms or accountability for delays, this gap continues to undermine the effectiveness of the IDR process. ASA will continue to press for stronger protections to ensure that successful IDR outcomes result in prompt and appropriate payment for anesthesiologists.
★Large employer lobbying organization attacks No Surprises Act Independent Dispute Resolution (IDR) process. On May 14, 2026, the ERISA Industry Committee (ERIC) along with more than 60 groups representing employers, labor, patients, and consumers urged The U.S. Departments of Labor, Health and Human Services, and Treasury (the Tri-Departments) to reform the NSA IDR. The group argues that the process drives up costs and skews payment determinations. For anesthesiologists, who are disproportionately affected by surprise billing restrictions, the IDR process has been one of the only viable mechanisms to secure fair market-based payments, even as the process remains highly flawed and insurers continue to underpay or delay reimbursement. The ASA continues active advocacy on implementation of the No Surprises Act, pushing for improvements to the IDR process and stronger enforcement to ensure physicians are paid appropriately for their services.
Date of last update: October 14, 2026
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