Zelis, a health technology company, launched a new AI-driven solution last week aimed at assisting payers in managing challenges related to the Independent Dispute Resolution (IDR) process under the No Surprises Act.
The No Surprises Act is designed to protect patients from unexpected medical bills and mitigate payment friction between insurers and providers. The law mandates that insurers and providers enter into open negotiations for 30 days to determine the payment amount to providers. If they fail to reach an agreement, either party can resort to the IDR process, where a provider submits a payment offer, an insurer submits a counter-offer, and a neutral arbiter (called the IDR entity) selects one of the offers.
However, many payers have argued that the IDR process is being exploited by some providers, who initiate the majority of cases and win most of the time at significantly inflated reimbursement rates. Zelis aims to address this issue with its new solution, named Zelis NSA Claim Advantage.
The solution comprises three key elements, according to Maisie Weir, Vice President of Strategic Solutions at Zelis. Firstly, it employs AI to streamline the admission process and ascertain which disputes are eligible. If a claim qualifies for open negotiation, the solution leverages Zelis’s data and the expertise of negotiators to facilitate more effective good-faith negotiations, thereby resolving more disputes before they escalate to IDR. Finally, when a case enters the IDR phase, the solution assists payers in constructing a stronger case to improve success rates.
Despite being an AI-driven solution, Weir emphasized that human oversight remains integral to the process. “There is a human in the loop for everything we do, and no submission or task is executed without human approval throughout this process,” she stated.
Research indicates that providers currently win approximately 88% of IDR cases, with payments often amounting to 300% to 900% of the median in-network rate. Initially, when the No Surprises Act was introduced, it was estimated that there would be around 17,000 arbitration cases each year; however, over 1.2 million cases were reported in just the first half of 2025.
“Payers really need better visibility, stricter execution of their processes, and a more disciplined approach to determine which disputes to settle, which to contest, and which should proceed based on eligibility,” Weir explained. “That’s why we launched Zelis NSA Claim Advantage.”
This launch comes shortly after the Centers for Medicare & Medicaid Services (CMS) announced a final rule regarding IDR in May. The rule aims to enhance communication between payers and providers while streamlining dispute processing. Zelis’s new solution was developed with consideration of this rule, Weir noted.
The IDR process has become a significant concern for payers. In a recent interview at the AHIP 2026 conference, a health insurance CEO remarked that the process “is clearly abused by a relatively small number of actors,” many of whom are backed by private equity.
“Nothing that happens in this process improves patient care, nothing at all. It merely directs funds into the pockets of certain players. It’s woefully abused, and it simply does not align with the intent behind the process when it was established and when the law was enacted,” said Paul Markovich, CEO of Ascendian, a nonprofit parent company of Blue Shield of California, Blue Shield Promise Health Plan, Altais, and Stellarus.
With the introduction of Zelis NSA Claim Advantage, the company hopes to ultimately advance metrics such as a reduction in avoidable disputes and more predictable arbitration outcomes, Weir stated.
Photo: Sakchai Vongsasiripat, Getty Images
