No Surprises Act Arbitration Update

The No Surprises Act IDR process has had many starts and stops this year, creating even a greater backlog of cases. Needless to say, it has not been a smooth roll out. During the period between April 15, 2022 and June 30, 2023, 490,000 disputes were initiated — more than 22 times the amount of disputes anticipated by the Departments of Health and Human Services, Labor, and Treasury (the “Departments”).[1] More than 60% of the disputes still have not been decided. Between the starts and stops and the too few number of IDR entities certified to handle the disputes, it could be a long time before the backlog is cleared out.

On December 15, 2023, months after shutting down the federal portal, the Departments reopened the portal for all dispute types — previously initiated disputes, batched disputes and air ambulance bills included. The Departments extended certain deadlines as outlined below:

  • If the initiation deadline was originally between August 3, 2023 and December 14, 2023, the provider has until March 14, 2024 to initiate a new batched dispute or air ambulance dispute.
  • If the initiation deadline was originally between December 14, 2023 and March 13, 2024, the provider has until March 14, 2024 to initiate a batched dispute or air ambulance dispute.
  • If the initiation deadline is after March 14, 2024, the provider has the standard 4 business days after the expiration of the Open Negotiation Period to initiate the dispute.

The Departments are also permitting disputing parties to request additional time to respond to the IDR entity’s requests for additional information (although no specific timeline was provided). Disputing parties may also request an additional 10 business days from the IDR entity to submit an offer. Finally, the disputing parties have 10 business days to jointly select an IDR entity without request through March 14, 2024 (then it reverts back to the original timeline).

Additionally, the government fee will also be increasing to $115 per party per dispute up from $50 for disputes initiated after January 21, 2024.

There are many more updates to come. We will continue monitoring the ever changing NSA landscape for further changes, reports, and outcomes.


[1] J. Dicken, A New Government Forum for Surprise Medical Bills Is Getting More Disputes Than It Can Handle So Far, 12/13/23, Accessed 12/15/23 at: See also: Government Accountability Office (GAO), Private Health Insurance: Roll out of Independent Dispute Resolution Process for Out-Of-Network Claims Has Been Challenging, GAO-24-106335, 12/12/23, Accessed 12/15/23 at: