Zelis, a healthcare technology company, launched a new AI solution last week that seeks to help payers manage issues with the Independent Dispute Resolution process of the No Surprises Act.
The No Surprises Act protects patients from unexpected bills and removes them from insurer-provider payment friction. The act requires insurers and providers to enter into 30 days of open negotiation to determine how much providers are paid. If they can’t come to an agreement, either side can use the Independent Dispute Resolution (IDR) process, in which a provider submits a payment offer and an insurer submits a payment offer and then a neutral arbitrator (called an IDR entity) picks one.
However, many payers are arguing that the IDR process is being abused by some providers, with providers initiating the vast majority of cases and winning most of the time at significantly inflated award levels. This is what Zelis hopes to solve with the new solution, called the Zelis NSA Claim Advantage.
The solution has three key components, according to Maisie Weir, vice president of strategic solutions at Zelis. The first is using AI to streamline the intake process and determine which disputes are eligible to move forward. If a claim is eligible for open negotiation, the solution leverages Zelis’ data and negotiators’ experience to support more effective good-faith negotiations and resolve more disputes before they move to IDR. Lastly, when a case does enter the IDR process, the solution helps payers put together a stronger brief to improve win rates.
While NSA Claim Advantage is an AI solution, it has human oversight, Weir noted.
“There is a human in the loop for everything that we’re doing, and nothing gets submitted, or no task is actioned on, without a human giving approval throughout that process,” she said.
Research shows that currently, providers win about 88% of IDR cases with payments that are 300-900% of the median in-network amount. When the No Surprises Act was first introduced, it was estimated that there would be 17,000 arbitration cases a year, but in just the first half of 2025, there were over 1.2 million cases.
“Payers really need better visibility, tighter execution on what they’re doing, and truly a more disciplined way to decide which disputes they should settle, which can be challenged, and which should actually go forward from an eligibility perspective,” Weir said. “That’s why we introduced Zelis NSA Claim Advantage.”
The launch of this solution comes shortly after CMS announced a final rule related to IDR in May. The rule seeks to improve communication between payers and providers and streamline dispute processing. Zelis’ new solution was built with this rule in mind, Weir noted.
The IDR process has been a major concern for payers. During a recent interview at the AHIP 2026 conference, one health insurance CEO declared that the process is “clearly being abused by a relatively small number of actors,” most of whom are private equity-backed.
“Nothing that’s going on in that process is improving patient care, not a thing. It’s just pouring money into the pockets of certain players. It’s being woefully abused, and it’s just not fulfilling the intent that it had when the process was set up and the law was passed,” said Paul Markovich, president and CEO of Ascendiun. Ascendiun is a nonprofit and parent company of Blue Shield of California, Blue Shield Promise Health Plan, Altais and Stellarus.
In launching Zelis NSA Claim Advantage, the company ultimately hopes to move the needle on metrics like fewer avoidable disputes and more predictable outcomes of arbitration, Weir said.
Photo: Sakchai Vongsasiripat, Getty Images
