Dive Brief:

Many claims that providers submit for dispute resolution under the No Surprises Act are actually ineligible for the process, according to a new survey from health insurance groups.

AHIP and the Blue Cross Blue Shield Association found plans identified 39% of the out-of-network disputes lodged for arbitration as ineligible. However, arbiters themselves decided only 17% of cases were improper, meaning more than half of ineligible cases resulted in binding payment determinations, according to the groups.

The findings are notable given disputes processed through surprise billing arbitration are more frequently won by providers and often result in payments well above in-network rates. As a result, providers are incentivized to submit as many disputes as possible — even if they

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