New IDR fee billing process for self-funded groups begins in 2026
Starting in 2026, Premera will begin passing through certain Independent Dispute Resolution (IDR) fees to self-funded employer groups for disputes managed by other Blue Cross Blue Shield plans.
The federal No Surprises Act established a process for resolving certain out-of-network payment disputes between health plans and providers. When the law was implemented, the Blue Cross Blue Shield Association temporarily adopted an approach in which the local Blue plan where care was provided paid dispute resolution fees on behalf of all Blue plans. This helped streamline administration as plans worked to meet the law’s significant operational requirements.
After several years of evaluating the ongoing work and costs associated with supporting the federal IDR process, Premera will begin passing through applicable out-of-area (OOA) IDR fees to self-funded groups.
What is an out-of-area IDR?
An out-of-area IDR occurs when a Premera member receives care outside Premera’s service area and a payment dispute is managed by the local Blue plan where the care was provided.
Under the No Surprises Act, providers and health plans may use the federal IDR process to resolve certain out-of-network payment disputes.
What fees may apply?
Applicable out-of-area IDR charges may include:
- Federal IDR fees
- Certified IDR entity fees
- A $1,000 Premera administrative fee for each out-of-area IDR case
The administrative fee helps support the work required to review invoices, validate and reconcile charges, process reimbursements, and provide reporting and oversight for these disputes.
When will billing begin?
Self-funded National Accounts
Fees related to out-of-area IDR disputes initiated on or after January 1, 2026, will be included in standard IDR reporting beginning in October 2026.
Self-funded Mid-Market Accounts
Fees related to out-of-area IDR disputes initiated on or after July 1, 2026, will be included in standard IDR reporting beginning in November 2026.
Additional billing information
Out-of-area IDR fees are billed only after Premera receives invoice information from the host Blue plan and completes required validation and reconciliation activities. Because of this process, there may be a delay between when a dispute is initiated or resolved and when associated fees appear on an invoice. In some cases, billing may occur several months after the dispute takes place.
Billing and reporting timelines depend on when information is received from the host Blue plan.