CMS Denies Recertification for Two No Surprises Act Arbiters

The Centers for Medicare & Medicaid Services this week declined to renew certification for two independent dispute resolution (IDR) entities, Island Peer Review Organization (IPRO) and Network Medical Review Company, according to Healthcare Dive's November 6, 2026 report. Both organizations had served as arbiters under the No Surprises Act, the 2022 federal law that governs billing disputes between insurers and out-of-network providers for emergency care and certain non-emergency services delivered at in-network facilities. Healthcare Dive reports that insurers welcomed CMS's decision, while critics have raised questions about whether the two entities were sufficiently impartial in resolving disputes. The outlet also reports that both arbiters said they intend to appeal.

The No Surprises Act's IDR process works like this: when an insurer and an out-of-network provider cannot agree on a payment rate, a certified third-party arbiter chooses between the insurer's final offer and the provider's final offer. The goal is to settle the payment dispute between the two businesses without pulling the patient into the fight or exposing them to a surprise bill for the difference.

This is a commercial health insurance story at its core, not a Medicare story. But because the IDR system is part of the same federal billing-dispute machinery that CMS also oversees for Medicare and Medicare Advantage, it's worth understanding what this decision does, and doesn't, change for Medicare Plan Path readers.

Why This Doesn't Change Medicare or Medicare Advantage Billing Rules

The No Surprises Act does not apply to Original Medicare or to Medicare Advantage plans. Congress wrote the law to cover group health plans, employer-sponsored insurance, and Affordable Care Act marketplace plans, specifically because Medicare already has its own, long-standing protections against balance billing. Providers who treat Medicare patients, including through a Medicare Advantage plan's network, are limited in what they can charge beyond the plan's allowed amount, and out-of-network emergency care is generally covered at in-network cost-sharing levels under Medicare Advantage network adequacy rules. So if you are enrolled in either Original Medicare or a Medicare Advantage plan, this week's CMS decision about IPRO and Network Medical Review Company does not change how a billing dispute involving your coverage gets resolved.

Where the news can matter is during the transition into Medicare. If you or a spouse are still on an employer plan, COBRA, or a marketplace policy while delaying Medicare enrollment because one of you is still working, that coverage is governed by the No Surprises Act. The IDR entities CMS certifies, or declines to recertify, are the arbiters that would referee a dispute over an out-of-network emergency bill or an air ambulance claim during that period. A household with one spouse on Medicare and one still on job-based coverage could have both systems in play at the same time.

Key Takeaway

This CMS decision concerns the No Surprises Act's commercial-insurance arbitration system, not Original Medicare or Medicare Advantage billing rules. If you're enrolled in Medicare, your balance-billing protections are unaffected. If you or a family member still carries employer, COBRA, or marketplace coverage while transitioning to Medicare, this case is worth tracking since it affects which arbiters review disputed out-of-network bills under that coverage.

What Medicare Plan Path Readers Should Do Next

First, confirm which coverage applies before disputing any bill. A charge tied to Original Medicare or a Medicare Advantage plan should go through that plan's grievance and appeals process, not the No Surprises Act's IDR system. Second, if you or a family member is still covered by an employer or marketplace plan and receives a surprise out-of-network bill, you keep the right to dispute it under the No Surprises Act regardless of which entity ends up certified to arbitrate. If you have an open dispute involving IPRO or Network Medical Review Company, ask your insurer's member services line how the case will be handled, since Healthcare Dive reports both companies may appeal CMS's recertification denial and the outcome could still change.

Third, treat this as a prompt to review your own coverage rather than a reason to worry about your current plan. Medicare's Annual Enrollment Period runs October 15 through December 7 each year, and checking whether a Medicare Advantage plan's provider network and out-of-network emergency coverage still fit your needs is worth doing on that schedule regardless of this specific dispute-resolution story. A licensed insurance agent or your State Health Insurance Assistance Program (SHIP) can walk through plan comparisons at no cost.

CMS has not published a detailed public rationale beyond the recertification denial itself, and Healthcare Dive's reporting attributes the impartiality concerns to critics rather than to CMS's own stated reasoning. The underlying dispute remains unresolved pending any appeal. Medicare Plan Path will watch for whether this decision leads to broader changes in how CMS oversees IDR entities, since that oversight model could eventually inform how Medicare Advantage plans and providers settle their own out-of-network billing disagreements.