Surprise-billing arbitration has a backlog. Washington’s remedy is to make filing cheaper and grouping easier.
New batching rules for the No Surprises Act’s dispute process have applied since November 1. The details arrived in a 26-page guidance document dated October 29, three days before the rules took effect.
The guidance is technical. Its examples are revealing.
Six Million Disputes and a Discount
The No Surprises Act created independent dispute resolution, or IDR, to settle payment fights between out-of-network providers and insurers. It was meant as a backstop. As of May 2026, Health Affairs reported, more than 6.3 million disputes had been initiated and nearly 5.9 million resolved.
Georgetown researchers found that in the first half of 2025, providers initiated 99.9 percent of disputes and won 88 percent. About 430,000 cases were still waiting at the end of June.
The final rule, published June 4, did not attack those numbers directly. It cut the per-party administrative fee from $115 to $15, effective for disputes initiated on or after June 11.
It also raised the batch cap to 50 line items, up from the 25 proposed in 2023. And it cut the cooling-off period after a batched dispute from 90 calendar days to 30 business days, about six weeks.
The guidance says the shorter lockout eases the complexity of applying the rule to batches. That is the stated reason. Volume does not come up.
Inference: filing volume will rise. That rests on Law360’s reporting that attorneys and policy experts expect lower fees and broader batching to bring more disputes, though they called the size of the effect unclear. The reasoning is plain: when something costs less and holds more, people use more of it.
Providers see it differently. The American College of Radiology welcomed the rule, citing radiologists’ complaint that the old batching rules blocked them from grouping their claims. Batching can mean fewer separate arbitrations.
Health Affairs also noted what the rule leaves alone: high provider win rates and award levels.
One Condition, Several Strangers
The statute allows batching for items related to the treatment of a similar condition. The guidance offers three ways to qualify.
The first is a single patient’s single encounter. The second is the same or a comparable billing code. The third applies to anesthesiology, radiology, pathology and laboratory work, where any codes within the same listed range will do.
That third path needs no shared patient, diagnosis or encounter. Example 3 in the guidance shows how it works.
Four patients arrive at one hospital after four separate car accidents. Anne gets a head CT. Bill gets a sternum X-ray.
The same out-of-network radiologist reads both, and the guidance lets her batch them. Both codes fall in the range 70010 to 71555, which the guidance labels “Head and Neck, Chest.”
Fabio’s lumbar CT and Trisha’s wrist X-ray cannot join them. Their codes sit in other ranges.
CMS’s fact sheet said batches needed a “clear organizing principle.” For these four specialties, the organizing principle is the coding manual’s table of contents. The guidance does not say why only these four specialties get the range pathway. The fact sheet says only that the pathway addresses the unique circumstances of certain medical specialties and provider types.
Inference: the range pathway favors providers whose work is billed line by line across many patients. The basis is the guidance’s own examples, which batch the claims of unrelated patients. The reasoning is that the pathway removes the patient and encounter requirements that otherwise confine a batch to one person’s care.
A Registry With No Date
Batching also requires the same payer. For fully insured coverage, that means the same issuer in the same state. For self-insured employer plans, it means the same plan, and plans that share a third-party administrator do not count.
Until a federal plan registry exists, the guidance says a self-insured plan is identified by its tax or employer identification number plus the three-digit plan number from IRS Form 5500. If there is no plan number, the plan’s name will do.
The regulation text asks for something different. A provider filing a dispute must identify the plan by its legal business name, or its sponsor’s, and give a registry number or attest that none was provided. The Form 5500 plan number is not on that list.
The registry has no date. It applies 90 business days after the Departments announce the functionality is ready, and the safety net for incorrectly batched disputes expires 120 days after that.
Meanwhile, an IDR entity that finds a dispute improperly batched is told to decide the items that were properly batched. The regulation says the entity takes no further action on the rest.
The fact sheet calls the administrative fee non-refundable and sets it per dispute, whatever the dispute’s eligibility. The guidance does not address fees on items that fall out.
The Fine Print Needs a Proofreader
The paperwork has seams. The rule itself needed a correcting amendment on August 28. It restored omitted regulation text, including language making payment determinations binding and not subject to judicial review, and reprinted the whole section that contains the batching rules. The Departments said it changed no policy.
The guidance has its own. The section on traditional add-on codes says the covered ranges appear in Tables 1, 2 and 3. Table 1 lists comparable codes across coding systems. The ranges are in Tables 2 through 4.
The regulation calls them Category I CPT code ranges. The guidance’s tables then list codes beginning with R and P, which are HCPCS codes, not CPT. A nearby footnote says HCPCS comparables cannot be batched within CPT ranges. How the two fit together is not explained.
Table 1 pairs one HCPCS code for high-risk screening colonoscopy, G0105, with three CPT codes. One is the diagnostic colonoscopy code, 45378. The other two describe colonoscopy through a stoma. The guidance says comparable codes qualify because they are the same item or service.
Inference: the two stoma pairings look wrong. The basis is an ASGE coding primer that describes the stoma codes as the ones for patients with a colostomy. The reasoning is that a screening exam and procedures done through a stoma, one of them placing a decompression tube, are not the same item or service. A coding specialist should confirm.
The cooling-off section has its own wrinkle. The regulation bars only the party that filed the earlier dispute from refiling. The guidance’s examples say neither party may initiate.
Timing deserves a caveat. Disputes need a 30-business-day negotiation period first, so the first batches under the new rules should not reach the portal until roughly mid-December. That is an inference, and it makes the three-day gap less pressing in practice.
Inquiries are being directed to CMS and the Departments of Labor and Treasury. Among the unanswered questions:
What volume of disputes and line items do the Departments project under the new fee and batching rules? What is the basis for treating unrelated patients’ claims in one code range as a similar condition? What happens to the fees on items an IDR entity drops as improperly batched once resubmission ends?
The guidance is meticulous about how to batch. On how many disputes that will produce, it says nothing.
