How to Start Open Negotiation Under the No Surprises Act, Step by Step

What Do You Need on Your Desk Before You Send the Notice?

Pull seven items from the claim file before you write anything. The notice is short under the rule text in force, but the federal IDR initiation form asks for the same facts later, so one gathering pass serves both.

If the payer left out the QPA or the contact details, you can still start. CMS's IDR timeline for claims says an initiating party may start open negotiation even when the plan or issuer failed to make some or all of the required disclosures. Write down what was missing and ask for it in writing, as covered in how to request QPA calculation details.

How Do You Send the Open Negotiation Notice, Step by Step?

What Should the Offer in the Notice Look Like?

Put a single dollar amount on each item or service. Federal IDR later requires each offer to be stated as a dollar amount and as the matching percentage of the QPA, so calculating that percentage now keeps your open negotiation figure and your later offer consistent.

No federal rule says what number is reasonable. Choose one you can explain in a sentence and would accept as a settlement. For the factors an IDR entity weighs if talks fail, read how to choose your IDR offer.

What Record Should You Keep for Each Notice?

Keep one folder per claim, because you will upload proof of the start date if the dispute goes to IDR. CMS's guide to the initiation web form asks for evidence of the open negotiation start date, such as a copy of the notice sent to the other party.

• The sent message with its header and timestamp, and the form as it left your office.
• The remittance advice and the payer's QPA disclosure, saved as received.
• The line showing where the payer's contact details came from.
• A dated log of every call or email, with the name of the person and any counteroffer.
• Any written agreement, since settling after IDR starts must be reported to the Departments within 3 business days.

CMS names missing proof of open negotiation as a common mistake when the other party says it never took place. The log is what answers that.

What Happens on Day 15 and Day 30 of Open Negotiation?

Under the rule text in force, the payer has no deadline to reply, and the clock keeps running whether it answers or not. You can keep negotiating through day 30, and CMS says disputing parties can continue to negotiate until the certified IDR entity makes a determination.

The 2026 IDR operations rule adds a response from the payer no later than the 15th business day, but that applies only to disputes whose open negotiation periods begin 90 calendar days after the Departments announce the portal functionality. The CMS Notices page lists no such announcement for open negotiation as of October 26, 2026. The rule changes no day count; see the 2026 IDR operations rule page for the full list. Plan on silence and follow up in writing.

On day 30, if no rate is agreed, either party has 4 business days to start federal IDR. The open negotiation reference page sets out the rule text for the notice itself.

What Does the Calendar Look Like for a Real Claim?

The dates are made up. The count skips weekends and federal holidays.

Sending on January 12 instead of the last permitted day pulls every later date forward. A notice sent on Friday, February 19 would push the end of open negotiation to Thursday, April 1, 2027.

Which Mistakes Cost Providers the Dispute Later?

• No proof of the start date. If the payer says open negotiation never happened, the IDR file needs the sent notice.
• Wrong contact. Sending to an address from your own files rather than the one on the remittance is a listed CMS mistake.
• Counting calendar days. Thirty calendar days ends weeks before the 30th business day, so you would start IDR too early and be rejected.

How We Handle Open Negotiation

We manage out-of-network reimbursement end to end: eligibility assessment, open negotiation, dispute submissions, deadline management, documentation validation and outcome tracking, under federal IDR and applicable state pathways, including Texas TDI. Our controls cover eligibility verification, deadline tracking, accurate documentation and required fees paid on time.

For emergency departments and freestanding ERs this sits alongside emergency medicine billing and our out-of-network billing and IDR service. More how-tos are on the blog. To hand off a batch of claims, book a call.