Fulcrum Health Partners is not an arbitrator, a certified IDR entity, or a revenue-cycle vendor paid on dispute volume. Our core work is negotiating durable in-network agreements between providers and payers. Every claim that reaches federal arbitration is a contract that did not happen, so our interest is in fewer disputes. Getting there requires an honest account of why they occur.
IDR Is the Symptom. The Broken Step Is the One Before It.
This report draws on twelve quarters of CMS IDR data (2023 through 2025), recent federal court decisions, the 2026 IDR Operations Final Rule and published research. Fulcrum’s own analysis of the CMS tables is labeled as such throughout.
IDR has become the default rather than the backstop.
2.56 million disputes were initiated in 2025, up 75% on 2024 and roughly 148 times the 17,333 annual resolutions regulators projected in 2021.
Payers are losing on the merits, not by default.
Providers won 87% of 2025 determinations. Even if every one-sided determination is assumed to be a provider default win, providers still won at least 83% of contested cases.
Concentration is greater on the payer side.
Seven payers and repricers were the non-initiating party in 85% of 2025 disputes; UnitedHealthcare alone accounted for 26%. The top eight filers accounted for 63%.
IDR is mostly an ASO problem.
68% of 2025 disputes involved self-funded employer plans. The carrier or repricer sets the payment and the offer; the employer pays the award.
Winning is not the same as being paid.
A 45-state survey found 11% of 2024 awards unpaid and half of paid awards late. Two federal appeals courts have held that providers cannot sue to enforce them.
The outliers are real, and narrow.
Neuromonitoring and surgical disputes clear at 14 to 25 times the QPA, and ineligible filings remain high. These are fixable problems, but they do not explain the system.
The No Surprises Act removed the patient from the dispute but left payers’ leverage intact. When a payer can set an initial payment below what a neutral arbiter will support, drag out negotiation, pay late without penalty, and pass the award through to an employer, IDR stops being a risk worth avoiding. Reform should hold payers to good-faith negotiation and timely payment and put guardrails on the small set of service lines and filers that produce extreme outcomes. The ten reforms below do both.
| Audience | What this report means for you |
|---|---|
| Providers & health systems | IDR outcomes are now the clearest public evidence of out-of-network value. Use them to negotiate in-network terms, and collect on awards you have already won. |
| Health plans & TPAs | An offer anchored only to the QPA loses about 8 times in 10. Offer strategy, not provider behavior, is the controllable variable. |
| Self-funded employers | You are the payer in two of every three disputes. Require IDR reporting from your administrator and review fees tied to out-of-network “savings.” |
| Investors & lenders | Underwrite IDR receivables at expected collection, not at award value, and treat outlier service-line awards as a regulatory risk. |
| Policymakers | Enforcing awards and good-faith negotiation would reduce dispute volume more than further limiting provider access to IDR. |
Built for Exceptions, Running at Industrial Scale
IDR was designed as a backstop for a few thousand disputes a year. It now processes more than half a million every quarter. Quarterly initiations have grown more than fivefold since early 2023, from 136,000 in Q1 2023 to 719,000 in Q4 2025, with the Q3 2023 dip reflecting a court-ordered pause in operations.
Dispute volume has nearly quadrupled in two years.
Federal IDR disputes initiated, by calendar year, all disputes including air ambulance.
Source: CMS Federal IDR Supplemental Tables, 2023 Q1 to 2025 Q4, Table 1; Fulcrum Health Partners analysis. Annual figures are sums of quarterly values. The 2021 interim final rule projected 17,333 disputes a year.
IDR fees grew roughly elevenfold in two years.
IDR entity compensation plus federal administrative fees, by calendar year.
Source: CMS Supplemental Tables, Table 6; Fulcrum Health Partners analysis. The PDF splits each bar into IDR entity fees and federal administrative fees; only the combined totals are printed, so only the totals are drawn here.
What the volume tells us. In the 2021 interim final rule, the Departments estimated that IDR would resolve 17,333 disputes a year, on the expectation that most claims would settle during the mandatory 30-business-day open negotiation period. That expectation has not held. Disputes rose from 679,000 in 2023 to 1.46 million in 2024 and 2.56 million in 2025. Facility-initiated disputes are the fastest-growing segment, doubling from 10% of filings in 2023 to 22% in 2025.
High volume is usually read as evidence of provider abuse. A simpler explanation fits the data better: open negotiation is not resolving claims. In finalizing the 2026 IDR Operations rule, the Departments said they had received “numerous reports that the parties are not meaningfully engaging in open negotiation” before going to IDR. A claim that a neutral arbiter will price at three times the QPA is a claim that should have settled.
Friction has a price. Federal administrative fees and IDR entity compensation reached $1.78 billion in 2025, up from $166 million in 2023. Because the losing party pays the IDR entity fee, that cost falls mostly on payers, and through ASO arrangements, on employers. The 2026 Final Rule cuts the administrative fee from $115 to $15 per party for disputes initiated on or after June 11, 2026. That makes IDR cheaper to use. It does nothing to make IDR less necessary.
Payers Are Losing on the Merits, Not by Default
The most repeated claim about IDR is that provider win rates prove the process is rigged. The process design and the data say otherwise. Providers prevail in more than four of five contested disputes, every quarter: CMS reports determinations in which “only one party submitted an offer and paid fees” without identifying which party, and assigning all of them to providers gives the lowest plausible contested win rate. The annual rates here are Fulcrum’s volume-weighted blend of the quarterly CMS tables; CMS’s own half-year summaries put the provider win rate at 88% for the first half of 2025 and 85% for the second.
How baseball arbitration works. An IDR entity cannot split the difference. It must select one party’s offer after weighing the QPA and the statutory factors. The more defensible offer wins. A party that consistently submits offers close to a benchmark it calculates itself, with no supporting evidence, should expect to lose most of the time, and payers do. Insurer offers were at or below the QPA in roughly 47% of 2024 disputes. When plans won, the median prevailing offer was 110% of the QPA in 2024. Prevailing offers exceeded the QPA in 87% of 2025 determinations.
The benchmark is part of the problem. The QPA is the payer’s own median contracted rate, calculated from contracts the provider cannot see. In August 2026, the en banc Fifth Circuit in Texas Medical Association v. HHS (TMA III) vacated key provisions of the QPA methodology rules. The court barred “ghost rates” for services a contracted provider never bills and held that incentive and risk-sharing payments may not be categorically excluded.
In a 14-state sample of emergency disputes, CRS found the median QPA slightly above the median in-network rate, while prevailing offers ran more than three times that rate. Not every gap reflects a low QPA, and some provider offers are aggressive. Both can be true.
| The claim | What the record shows |
|---|---|
| “Providers win because payers don’t show up.” | Excluding every one-sided determination, providers still won at least 83% of contested 2025 disputes. |
| “High-volume filing proves fraud.” | Insurer fraud and RICO suits over IDR filings were dismissed with prejudice in Texas, Georgia and Florida federal courts in 2026. |
| “IDR is why premiums are rising.” | CBO projected the NSA would reduce private insurance premiums by 0.5% to 1%. IDR costs are real (Georgetown estimates $2 billion to $2.5 billion a year through 2024), but no published estimate separates them from the low initial payments that generate disputes. |
Concentration Runs Both Ways, and Is Higher on the Payer Side
Critics focus on a handful of high-volume filers. The same CMS tables show an even more concentrated group on the other side of those disputes.
Seven payers and repricers: 85% of 2025 disputes.
Disputes as non-initiating party, 2025, as a share of all 2025 disputes.
Source: CMS Supplemental Tables, Tables 8 and 9 (top 10 parties or their representatives, OON emergency and non-emergency services), summed across the four 2025 quarters; Fulcrum Health Partners analysis. Shares use total 2025 disputes as the denominator. Claritev (formerly MultiPlan) and ClearHealth Strategies appear as representatives of plans. The PDF also splits each bar between self-funded employer plans and all other plan types; that split is not printed, so it is not drawn.
Eight initiating parties: 63% of 2025 disputes.
Disputes initiated, 2025, as a share of all 2025 disputes.
Source: CMS Supplemental Tables, Tables 8 and 9, summed across the four 2025 quarters; Fulcrum Health Partners analysis. Shares use total 2025 disputes as the denominator.
Reading the concentration. On the provider side, volume is driven by large hospital-based groups (emergency, radiology, anesthesia) and by intermediaries that file on behalf of many smaller practices. HaloMD alone initiated 19% of 2025 disputes. Intermediaries give smaller practices access to a process most could not navigate alone, but they also bring filing volume and award levels that warrant scrutiny. On the payer side, UnitedHealthcare, BCBS of Texas and Aetna together accounted for 56% of 2025 disputes. When most disputes trace back to the payment policies of a few organizations, those policies are the most efficient place to intervene.
| State, Q4 2025 | Disputes | Share |
|---|---|---|
| Texas | 280,355 | 39% |
| Arizona | 44,934 | 6% |
| Florida | 40,377 | 6% |
| California | 38,053 | 5% |
| New Jersey | 37,151 | 5% |
| All other states and territories | 280,321 | 39% |
Geography follows the same pattern. Texas generated 39% of disputes in Q4 2025, with roughly 9% of the U.S. population. BCBS of Texas’s dispute volume rose 72% from Q1 to Q4 2025. Source: CMS Supplemental Tables, Table 7.
Proposals aimed only at filers, such as higher fees, tighter batching and filing caps, would raise the cost of disputes for every provider, including the small practices that file through intermediaries. Proposals aimed at the payment practices of the few organizations on the other side of most disputes would reduce volume at its source. Both sides warrant scrutiny. The data say the payer side is the more concentrated lever.
The ASO Gap: The Party That Decides Is Not the Party That Pays
Two of every three IDR disputes involve a self-funded employer plan. In those arrangements, the carrier or TPA runs the claim and the employer funds it.
Self-funded employer plans are the payer in two of every three disputes.
2025 federal IDR disputes by plan type.
Source: CMS Supplemental Tables, Table 3, 2025 Q1 to Q4; Fulcrum Health Partners analysis. The PDF’s stacked bar also carries a Federal Employees Health Benefits (FEHB) segment whose share is not printed; it accounts for the remainder and is omitted here rather than read off the graphic.
| Decision in an OON claim | Who makes it (ASO) | Who bears the cost if it is wrong |
|---|---|---|
| Initial payment amount | Carrier, TPA or repricer | Employer plan, through IDR awards and fees |
| QPA calculation | Carrier, using its own contract data | Employer plan, and the patient’s cost-sharing |
| Open negotiation and IDR offer | Carrier, TPA or repricer | Employer plan, which pays the award and the losing IDR entity fee |
| Timing of award payment | Carrier or TPA | Provider, which finances the delay |
Why administrators tolerate IDR. Under an administrative-services-only (ASO) contract, the carrier earns administrative fees, and the employer funds claims. Four features of that model weaken any incentive to keep claims out of IDR.
Pass-through
Awards, IDR entity fees and internal costs flow to the plan sponsor. Self-funded employers report IDR awards adding 1% to 6% to health-cost trend.
Savings-based fees
Some carriers and repricers charge employers a percentage of the difference between billed charges and the amount paid on out-of-network claims. A lower initial payment produces a larger fee, as The New York Times documented in 2024.
Float
An award paid late carries no statutory interest or automatic penalty. The provider finances the delay.
Network leverage
A low, payer-calculated QPA is a credible threat in rate negotiations. In 2021, as the NSA took effect, physician groups reported carrier letters demanding 10% to 40% rate cuts or termination, citing the new law.
These are structural incentives, not findings of misconduct by any company. Antitrust claims over out-of-network repricing remain in active litigation. The point for employers is simple: if you fund the award, you should see the offer.
Fully insured and individual-market plans account for about one in five disputes. There, IDR costs flow into claims expense and, over time, into premiums. The relevant measure is the cost above what a reasonable initial payment would have produced, and that figure is rarely disclosed.
Payers Are Not Paying, and Nothing Happens When They Don’t
A binding decision is only as strong as its enforcement. On that measure, the No Surprises Act has the largest gap in its design.
Day 0 · Initial payment or denial
Payer sets the amount and discloses a QPA it alone can verify.
30 business days · Open negotiation
Meant to settle most claims. CMS reports parties often do not engage meaningfully.
Days to months · IDR determination
Statute: 30 business days. Q4 2024 median for line items: 81 days.
30 business days · Payment due
Half of 2024 payments arrived late; some never arrived.
After that · Enforcement
No statutory interest, no automatic penalty and, in two circuits, no private lawsuit.
The enforcement vacuum. In Guardian Flight v. Health Care Service Corp., the Fifth Circuit held that the NSA creates no private right of action to enforce IDR awards; the Supreme Court declined review in January 2026. On September 17, 2026, the Second Circuit reached the same result in East Coast Advanced Plastic Surgery v. Cigna. A Maryland federal court has ruled the other way, so the circuits may split. For now, enforcement in much of the country depends on an administrative complaint process that physician groups describe as slow and without penalties for repeat offenders.
The bipartisan No Surprises Act Enforcement Act (S. 2420 / H.R. 4710) would authorize penalties for parties that miss post-determination payment deadlines and give regulators explicit enforcement authority. As of this writing, it has not passed either chamber.
Shifting cost to patients
In a 2024 study, 50% of emergency physician respondents reported that plans increased patient cost-sharing after an IDR decision in the physician’s favor.
Reopening closed cases
Physician organizations report plans using narrow June 2025 technical guidance to reopen final determinations and withhold payment.
Withholding eligibility information
Payers hold the plan data needed to determine NSA eligibility but often do not supply it with the initial payment. The 2026 Final Rule now requires CARC/RARC codes and payer registration.
Collateral litigation
Insurer suits alleging fraudulent IDR filings by BCBS of Texas, BCBS of Georgia and Aetna were dismissed with prejudice in 2026. The Georgia court said high win rates did not signal fraud and pointed instead to a pattern of lowball offers.
| Tool | Status, October 2026 | Practical gap |
|---|---|---|
| Administrative complaint (CMS / DOL) | Available nationwide | No published timeline or penalty schedule for repeat non-payers; physician groups describe it as slow. |
| Private lawsuit to enforce the award | Barred in the Fifth and Second Circuits; permitted by a Maryland federal court | A provider’s remedy depends on where it practices. Supreme Court review is possible. |
| Interest on late payment | None in statute | The provider finances every day of delay at no cost to the payer. |
| Statutory penalties for non-payment | Proposed (S. 2420 / H.R. 4710) | Not enacted. |
The Outliers Are Real, and They Are Narrow
An independent view has to name the provider-side problems too. They exist. They are concentrated in a few service lines, claim sizes and filing practices.
Two service lines clear at 14 to 25 times the QPA. Core hospital-based specialties clear at about 3 to 5 times.
Median prevailing offer as a multiple of the QPA, 2025 (volume-weighted average of quarterly medians).
Source: CMS Supplemental Tables, Tables 13 and 14; Fulcrum Health Partners analysis. Specialties grouped by CMS CPT ranges: Neurology/Neuromuscular (95700–96020) includes intraoperative neuromonitoring; Surgery (10004–69990). Volume-weighted averages approximate, but are not identical to, an annual median.
The highest multiples sit on the smallest claims.
Median prevailing offer ÷ QPA, by QPA size of the disputed item, Q4 2025.
Source: CMS Supplemental Tables, Tables 13 and 14; Fulcrum Health Partners analysis.
Neuromonitoring and surgery
Volume-weighted median awards of 24.8× and 14.1× the QPA in 2025, up from 11.9× and 9.4× in Q1 2024. Together these two service lines produced about 340,000 determinations in 2025. Multiples this far from every other specialty need a clinical or market explanation, not a procedural one.
Low-dollar claims
Items with a QPA under $100 cleared at 5.2× the QPA. The percentages are high but the dollars are small. Each dispute still costs both sides fees and administrative time.
Intermediary filings
Georgetown researchers found disputes filed by one large intermediary cleared at a median of 934% of the QPA in 2023 and 2024, against 445% for all provider wins in 2024.
Geographic skew
Four states produced 63% of decided line items in 2023 and 2024, driven largely by a few provider organizations.
Eligibility: both sides are overreaching. About 18% of disputes closed in 2025 were found ineligible, too many filings that should never have entered the portal. But payers challenged eligibility on 41% of disputes, more than twice the rate at which disputes were actually found ineligible. Source: CMS Supplemental Tables, Tables 4 and 5.
What Is Working, and What Is Not
Fulcrum’s assessment of the IDR system as of October 2026, after the IDR Operations Final Rule and the TMA III decision.
| Element | Status | Assessment |
|---|---|---|
| Patient protection | Working | Balance billing for covered emergency and facility-based services has largely ended, and consumers’ cost-sharing has fallen. This is the law’s core achievement and should not be traded away. |
| Neutral review | Working | Baseball arbitration gives both sides a strong reason to make defensible offers, and the outcomes are published. Federal courts have rejected insurer attempts to attack awards through RICO and fraud claims. |
| Data transparency | Working | Quarterly public use files now identify the IDR entity on every line item (2025 Q3 onward), making arbiter-level consistency testable for the first time. |
| Process mechanics | Improving | The 2026 Final Rule cuts the administrative fee to $15, moves open negotiation into the portal with a 15-business-day response, requires CARC/RARC eligibility codes and a payer registry, and allows up to 50 items per batched dispute. |
| QPA integrity | Improving | TMA III vacated the methodology that allowed ghost rates and excluded incentive payments. Recalculation guidance is pending, and regulators continue to exercise enforcement discretion in the meantime. |
| Open negotiation | Not working | Designed to resolve most disputes; it resolves few. The Departments acknowledge parties are not engaging meaningfully. Volume running 148× the forecast is the consequence. |
| Award payment and enforcement | Not working | Unpaid, late and short-paid awards with no statutory interest or automatic penalty, and no private enforcement in the Fifth and Second Circuits. |
| Patient cost-sharing after awards | Not working | Reports of plans reprocessing claims to raise patient cost-sharing after a provider wins work directly against the law’s purpose. |
| ASO accountability | Not working | The party setting payments and offers is often not the party paying awards, and employers rarely receive IDR-level reporting from their administrators. |
| Eligibility screening | Mixed | About 18% of closures are ineligible filings, while payers challenge 41% of disputes. Both sides are overreaching. New payer disclosure rules should help if they are enforced. |
| Outlier awards | Mixed | Core specialties clear at about 3 to 5 times the QPA. Neuromonitoring and surgery clear at 14 to 25 times, with no published IDR entity rationale available to test them. |
| Timeliness | Mixed | Closure rates have improved, but median time to determination has run nearly three times the statutory 30 days, and a backlog of roughly 430,000 disputes remained in mid-2025. |
The parts of the system that depend on neutral parties (arbitration, data, courts) are working or improving. The parts that depend on payer conduct (negotiation, payment, cost-sharing, ASO reporting) are not. The provider-side problems are real, but they sit in a few clearly identifiable places.
Ten Reforms: Accountability for Payers, Guardrails for Outliers
Each reform targets a cause identified in the data. None requires reopening patient protections or abandoning neutral review.
Hold payers to good faith.
| # | Reform | Mechanism | Who acts |
|---|---|---|---|
| 1 | Enforce awards automatically | Statutory interest from day 31; escalating civil penalties for repeat late or partial payment; carrier-level compliance published quarterly (S. 2420 / H.R. 4710 framework). | Congress; HHS, DOL, Treasury |
| 2 | Make open negotiation real | Require a written counteroffer with supporting rationale within the Final Rule’s 15-business-day window. A party that does not respond forfeits the right to submit a lower IDR offer. | The Departments |
| 3 | Verify the QPA | Recalculate under TMA III; confidential regulator audits of QPA inputs; disclose method, contract count and geography with the initial payment. | CMS, DOL |
| 4 | Protect the patient after the award | Prohibit reprocessing that raises patient cost-sharing after a determination; limit reopening of closed cases to defined cause. | The Departments |
| 5 | Close the ASO gap | Administrators report to plan sponsors each quarter: disputes, offers, awards, fees and any compensation tied to out-of-network “savings.” Employers treat this as a fiduciary review item. | Employers; DOL |
Rein in the outliers.
| # | Reform | Mechanism | Who acts |
|---|---|---|---|
| 6 | Gate eligibility at the portal | Use mandatory CARC/RARC codes and the payer registry to screen filings automatically. Graduated sanctions for repeat ineligible filers and for repeat unsupported eligibility challenges. | CMS; IDR entities |
| 7 | Review outlier awards | Require a reasoned written decision for awards above a defined multiple of the QPA; audit outlier service lines such as neuromonitoring and surgery by IDR entity. | CMS; IDR entities |
| 8 | Hold IDR entities to consistency | Use the new entity-level PUF data to publish win rates and award distributions by entity and service line, with performance reviews for statistical outliers. | CMS |
| 9 | Create a low-dollar track | Expedited or bundled handling for items with a QPA under $100, where fees and administrative time can exceed the amount in dispute. | The Departments |
| 10 | Publish searchable outcome data | A carrier-level and filer-level public database of QPAs, offers, awards, default status and payment timing, so policy is set on evidence, not anecdote. | CMS |
Every reform above treats the symptom. The cure is a sustainable in-network agreement. A payer and a provider group that agree on rates never meet in the IDR portal. The IDR record now gives both sides public, neutral evidence of out-of-network value, which is the basis for a contract both can accept. That is where Fulcrum works.
What Each Stakeholder Should Do Now
The IDR record changes negotiating positions on both sides. These are the practical next steps for each audience.
| Audience | Next steps |
|---|---|
| Providers & health systems | Track every award to payment. Document late, short and unpaid awards and file administrative complaints. The record matters for enforcement and for your next negotiation. Use your own IDR outcomes, not national medians, as evidence of value in in-network rate discussions. Screen eligibility before filing. Ineligible filings cost money and weaken credibility with IDR entities and regulators. Audit QPAs on high-volume codes against TMA III. Recalculated QPAs may support reprocessing. |
| Health plans & TPAs | Treat an 80%-plus loss rate as feedback on offer strategy. QPA-anchored offers without supporting evidence lose. Pay awards on time. Interest and penalties are likely to follow, and repeat non-payment invites the enforcement now under discussion. Negotiate in open negotiation. Each claim settled there avoids IDR entity fees on both sides. Prepare QPA recalculations for TMA III guidance. Audit the offers repricers and vendors submit in your name. You own the outcome. |
| Self-funded employers | Ask your administrator for a quarterly IDR report: disputes, offers, awards, fees, timeliness. Identify any fee tied to out-of-network “savings” and test whether it rewards low initial payments. Review network adequacy for emergency, anesthesia, radiology and hospitalist services. Gaps there produce disputes. Consult benefits counsel on fiduciary oversight of out-of-network claims handling. Confirm whether your stop-loss contract covers IDR awards and fees. |
| Private equity & lenders | Value IDR receivables at expected collection after payment delay and non-payment, not at award value. Separate core hospital-based IDR economics (about 3 to 5 times the QPA) from outlier service lines (14 to 25 times) when underwriting earnings durability. Diligence payer concentration. A portfolio exposed to the few payers that generate most disputes carries both upside and enforcement risk. Model a reform scenario: enforcement benefits providers, while outlier review compresses extreme multiples. |
| Policymakers & regulators | Close the enforcement gap first. It affects every specialty and every state, and the legislation already exists. Target outliers precisely, by service line, multiple and filer, rather than lowering the bar for every dispute. Use the new IDR-entity-level data to audit consistency. Extend transparency to the ASO chain, so employers can see how disputes are handled on their behalf. |
The No Surprises Act’s arbitration process is doing what neutral review is supposed to do: rejecting offers it finds indefensible. The disorder around it comes from what happens before and after arbitration, including low initial payments, negotiations that do not happen and awards that are not paid. Fix those, put precise guardrails on the outliers, and dispute volume will fall because the incentive to avoid IDR will finally exist on both sides.
How We Built This Analysis
Data. Fulcrum Health Partners compiled all twelve quarterly CMS Federal IDR Supplemental Tables from 2023 Q1 through 2025 Q4, the most recent available. We used dispute initiations (Table 1), plan type (Table 3), eligibility (Tables 4 and 5), fees (Table 6), state (Table 7), top parties (Tables 8 and 9), outcomes (Table 12) and prevailing offers relative to QPA (Tables 13 and 14). Annual figures are sums of quarterly values. Dispute counts include air ambulance unless noted.
Calculations. The conservative contested win rate assigns every determination in which only one party submitted an offer to the provider side and removes it from both numerator and denominator. Party concentration sums each party’s quarterly top-10 counts across 2025 and divides by total 2025 disputes; the seven payers shown appeared in the top 10 in all four quarters. Specialty multiples are volume-weighted averages of CMS-reported quarterly medians. They approximate, but are not identical to, an annual median.
Limitations. Supplemental tables report counts and medians, not dollar amounts paid. Award non-payment figures come from provider-side surveys and should be read as indicative. “Non-initiating party” counts include representatives, such as repricers, acting for plans. CMS figures are subject to revision. Analysis and recommendations are Fulcrum’s own and distinguish fact from interpretation. Nothing in this report is legal advice; organizations should review specific matters with counsel.
Independence. No payer, provider, IDR entity or intermediary commissioned or reviewed this report. Panel or speaking participation by any organization named here does not imply endorsement of its conclusions.
Sources
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- ERISA Industry Committee (ERIC). Employer Exposure Under the No Surprises Act, white paper, Sept. 17, 2026. eric.org
- Insurance Business, “MultiPlan antitrust ruling raises questions for self-funded plans,” Sept. 2026; HFMA, “MultiPlan antitrust litigation gains momentum,” 2026 (In re MultiPlan, MDL 3121, N.D. Ill.). insurancebusinessmag.com; hfma.org
- USC Schaeffer Center, “Who Are the Winners in the No Surprises Act?” (CBO premium estimate). schaeffer.usc.edu/research/who-are-the-winners-in-the-no-surprises-act