Glossary
The No Surprises Act, in plain words.
Every term in the dispute process, defined the way the engine and the portal use it.
A
- Administrative fee
- The non-refundable fee each party pays the Departments for every federal IDR dispute. $15 per party for disputes initiated on or after June 11, 2026; $115 before that.
- Air ambulance services
- Medical transport by helicopter or fixed-wing aircraft. Covered by the No Surprises Act when the plan covers air ambulance, with extra factors the IDRE must weigh, such as aircraft type and pick-up location.
- All-payer model agreement
- A state arrangement with CMS that sets payment rates across payers (Maryland is the example). Where one applies, it sets the out-of-network rate instead of IDR.
B
- Batching
- Filing several items or services as one dispute. Under the 2026 operations rule a batch can hold up to 50 items, grouped by one patient encounter, by the same or a comparable service code, or for anesthesiology, radiology, pathology and laboratory services by CPT section.
- Business day
- Any day except Saturday, Sunday and federal holidays. Most federal IDR clocks run in business days; payment and the cooling-off period run in calendar days.
C
- Certified IDR entity (IDRE)
- An independent organization certified by the Departments to decide payment disputes. The parties choose one jointly or the Departments assign one.
- Cooling-off period
- The 90 calendar days after a determination during which the initiating party may not file a new dispute against the same party for the same or similar item. Items furnished during that period can be filed in the 30 business days after it ends.
E
- Eligibility
- Whether a claim can go to federal IDR at all: the right service type, plan type, timing and no specified state law. Under the 2026 rule the IDRE decides it within 5 business days of selection.
- Emergency services
- Screening and stabilizing care for an emergency medical condition, in an emergency department or freestanding emergency facility, and some care after stabilization. Covered by the No Surprises Act in or out of network.
F
- Federal IDR portal
- The online system where federal disputes are filed and managed. Under the 2026 rule, open negotiation notices also go through it.
I
- IDRE fee
- The fee the certified IDR entity charges for a dispute. Both parties pay it with their offers; the entity refunds the prevailing party.
- Initial payment
- What the plan first pays on an out-of-network claim, or its notice of denial. It starts the 30-business-day window to begin open negotiation.
- Initiating party
- The party that files the dispute, usually the provider or facility. The other side is the non-initiating party.
L
- Line item
- One item or service on a claim. Batches are counted in line items, up to 50 under the 2026 rule.
O
- Offer
- Each party’s proposed payment amount, submitted with supporting information within 10 business days of IDRE selection. The IDRE chooses one of the two.
- Open negotiation
- The required 30-business-day period, started by a notice from either party within 30 business days of the initial payment, during which the parties try to agree before IDR.
- Out-of-network rate
- What the plan finally owes: set by a specified state law or all-payer model where one applies, otherwise by agreement or by the IDRE.
P
- Payment determination
- The IDRE’s decision. It picks one party’s offer in full, with a written explanation, within 30 business days of its selection.
- Prevailing party
- The party whose offer the IDRE selects. It gets its IDRE fee back.
Q
- Qualifying payment amount (QPA)
- The plan’s median contracted rate for the same service in the same area, trended forward. The patient’s cost sharing is based on it, and the IDRE must consider it along with the other information the parties submit.
R
- Remittance advice (835)
- The electronic file a payer sends with a payment, listing what was paid on each claim line and why. It is how awards are matched to cash.
S
- Self-funded and fully insured plans
- A self-funded employer plan pays claims itself and is regulated federally (ERISA). A fully insured plan is bought from an insurer and regulated by the state. The difference decides federal or state IDR.
- Specified state law
- A state law that sets a method for determining the out-of-network rate. Where one applies to the plan and the claim, the state process replaces federal IDR.
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