Purpose of the IDR Process

The IDR framework was created to protect patients from unexpected medical bills when they unknowingly receive out-of-network care, most commonly in emergency or facility-based situations.

Rather than passing disputed charges to patients, the law requires providers and insurers to resolve payment disagreements through arbitration:

• Providers submit a proposed payment amount
• Insurers submit a counteroffer
• A certified independent arbiter selects one of the two offers

While the process has largely succeeded in shielding patients from surprise billing, the growing volume of disputes continues to test the system’s efficiency.

Faster Processing, But Persistent Challenges

CMS reports that arbitrators processed over 1.3 million disputes in the first half of 2025—nearly 50% more than in the previous reporting period. This progress has carried into 2026, helping reduce backlogs that accumulated during the early years of IDR implementation.

Despite these gains, several challenges remain:

• A significant share of submitted cases are ineligible for IDR
• Eligibility reviews continue to slow case resolution
• Dispute filings remain highly concentrated among a small number of provider groups

Approximately 20% of disputes submitted in early 2025 were ultimately found to be ineligible. Although this figure has declined as arbitrators refine review processes, ineligible cases still consume time and resources.

Disputes Concentrated Among a Small Group of Providers

CMS data shows that dispute activity remains heavily concentrated. The top 10 initiating parties accounted for nearly 70% of all disputes filed in the first half of 2025.

Many of these organizations are backed by private equity, prompting insurers to argue that IDR is increasingly being used as a revenue strategy rather than a last-resort resolution mechanism.

Providers Continue to Win Most Cases

Providers prevailed in approximately 88% of IDR decisions, an increase from late 2024 levels. When providers win, awarded payment amounts often reach three to four times higher than typical in-network reimbursement rates.

Insurers contend this dynamic inflates healthcare costs and encourages out-of-network billing practices. Providers counter that these outcomes reflect insurers’ tendency to submit unrealistically low initial payment offers.

System-Wide Cost Implications in 2026

While consumers remain protected from surprise bills, IDR’s broader financial impact is becoming clearer. Research published in Health Affairs estimates that IDR contributed approximately $5 billion in additional healthcare spending during its first three years.

As the healthcare system moves further into 2026, stakeholders are increasingly focused on whether regulatory adjustments can rein in costs without undermining patient protections.

What Comes Next for IDR in 2026

CMS has indicated that forthcoming regulatory updates will aim to:

• Strengthen eligibility screening
• Reduce administrative delays
• Accelerate payment determinations
• Improve consistency across arbitration outcomes

Until those changes are finalized, the IDR process remains a critical—but evolving—component of the No Surprises Act, with growing implications for providers, insurers, and the overall cost of U.S. healthcare.

No Surprise Bill specializes in Independent Dispute Resolution (IDR) support for healthcare providers navigating the complexities of the No Surprises Act. As IDR volumes rise and eligibility rules tighten, our team helps providers file compliant disputes, reduce ineligible submissions, and maximize appropriate reimbursement.

Stay ahead of CMS updates with expert-backed IDR guidance. Visit us to streamline your IDR strategy and protect your revenue.