NSA Independent Dispute Resolution Tool

The No Surprises Act (NSA), effective January 1, 2022, established a federal independent dispute resolution (IDR) process for resolving payment disputes between out-of-network providers and health plans for covered services. The NSA applies to emergency services, qualifying non-emergency services at in-network facilities, and out-of-network air ambulance services. The IDR process uses baseball arbitration — a certified IDR entity selects one of two submitted offers as submitted, with no compromise available.

Covered plans include fully insured group health plans, self-funded ERISA group health plans, and non-grandfathered individual and small group market plans. Medicare, Medicaid, CHIP, grandfathered plans, and short-term limited-duration plans are not subject to NSA IDR. The IDR process timeline is strictly business-day-based under 5 U.S.C. §6103(a): open negotiation period (30 business days), IDR initiation window (4 business days), entity selection (3 business days), offer submission (10 business days), and determination (30 business days). Missing the IDR initiation window after open negotiation closes forfeits the right to IDR for that dispute.

IDR entities must consider the Qualified Payment Amount (QPA) — the payer's median contracted rate — along with provider qualifications, market share, patient acuity, teaching hospital status, and prior contract history. Following TMA v. HHS litigation (W.D. Tex., 2022–2025), there is no directional presumption toward the QPA. Offer documentation quality is the primary determinant of outcomes above QPA.

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