The Coalition Against Surprise Medical Billing and the ERISA Industry Committee sent letters to federal officials in late October, calling for more rigorous scrutiny of independent dispute resolution arbitrators under the No Surprises Act.
Collectively, the groups represent employers, unions and health insurers. The IDR process is a federal arbitration system under the No Surprises Act in which a provider and a health plan that cannot agree on payment for an out-of-network service each submit an offer, and a certified third-party entity selects one. The initiating party kicks off the process and proposes an IDR entity first, according to CMS.
Both letters cited Georgetown University research that found the IDR system cost $22.4 billion from 2022 through 2025. Looking at 2025 public use files, Georgetown researchers found providers won 85% of disputes, CASMB’s letter said.
In its letter to CMS, HHS, and the Labor and Treasury departments, CASMB requested a pause in IDR entity recertifications until higher standards are established and made public. The coalition also requested at least a 30-day public comment period before any recertification decision is finalized.
The letter came in response to an Oct. 16 announcement of five recertification applications. Three additional entities have entered the petition period since the letter.
“Arbitrators applying the same statutory factors to comparable disputes should not reach such markedly different results,” the CASMB letter said.
According to the letter, in the fourth quarter of 2025, one entity chose the provider’s offer in 99.4% of disputes, giving a median award of 601% of the qualifying payment amount. During that same quarter, another selected a provider’s offer in 54.5% of disputes and issued a median award of 159% of the qualifying payment amount.
On behalf of large employers, Melissa Bartlett, senior vice president of health policy at ERIC, said that outcomes suggest some IDR entities consistently favor high-volume initiating parties. A handful of provider groups and intermediaries are responsible for initiating many disputes. She said CMS should consider these patterns when weighing recertification.
Ms. Bartlett requested that CMS factor in how often an entity’s determinations involve ineligible disputes, how its awards relative to the qualifying payment amount compare with other entities, how well it explains decisions, timeliness and reporting compliance, and any financial ties to high-volume filers or affiliates. ERIC encouraged CMS to deny or revoke certification for entities that could not show compliance with the No Surprises Act.
“In the absence of stronger oversight, transparency and accountability, the IDR process risks becoming a tool for manipulation rather than a fair and efficient means of resolving payment disputes,” ERIC’s letter said.
The letters build on past pushback, including payer lawsuits that allege providers have been abusing the IDR process.
CMS told Becker’s that the agency does not post petitions, letters challenging certification or recertification or its own responses.
Becker’s has contacted HHS, the Labor Department and the Treasury Department and will update this story if more information becomes available.
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