Healthcare technology firm Zelis has introduced an AI-native automation platform designed to assist health insurance plans in managing the complexities of Independent Dispute Resolution (IDR). Announced on July 1, 2026, the new solution arrives as the industry grapples with an unprecedented volume of out-of-network claims originating from the legislation passed in 2020. This software streamlines the entire lifecycle of the No Surprises Act process, covering everything from the initial repricing of claims and open negotiations to case management and final resolution. The launch follows a late May federal rule change by the Centers for Medicare and Medicaid Services (CMS) that overhauled existing protocols. This updated regulation, finalized alongside the Departments of Health and Human Services, Labor, and Treasury, reduced administrative fees from $115 to $15 and introduced standardized claim codes to clarify IDR eligibility for providers.
The Zelis solution integrates predictive intelligence to analyze provider patterns and Independent Dispute Resolution Entity (IDRE) behaviors, allowing payers to optimize their settlement strategies and challenge non-qualifying disputes more effectively. By replacing manual workflows with automated intake, documentation, and escalation alerts, the platform seeks to minimize operational blind spots and prevent financial leakage caused by missed deadlines. Jim Bridges, president of price optimization at Zelis, commented in a statement: “Rule changes by CMS and HHS have improved the efficiency and long-term sustainability of the NSA, but payers are overwhelmed by complexity and costs associated with the IDR process.” He further explained, “Zelis NSA Claim Advantage gives payers a smarter way to manage the IDR lifecycle. It combines AI-native automation, data-driven intelligence and human review across every step in the journey to identify risks earlier, reduce avoidable disputes and replace the guesswork with predictable outcomes.”
Market data indicates that the federal IDR portal has faced an influx of disputes nearly 14 times higher than the government’s initial 2022 projections, with annual volumes now exceeding 100 times those early estimates. Since the establishment of these procedures in April 2022, over 5 million disputes have been submitted to the IDR phase. Recent figures from a 2025 HHS fact sheet suggest that providers have maintained a significant advantage in arbitration; in the second quarter of 2025, provider-suggested rates were selected in approximately 87% of closed cases. Zelis, which serves over 750 payers including major national health plans and TPAs, successfully processed $2.39 billion in savings related to the No Surprises Act process during 2025, with only 8% of those claims ultimately escalating to the arbitration stage.
