No Surprises Act

Which claims can you batch in one IDR dispute

You can batch claims that pass four tests in 45 CFR 149.510(c)(4)(i): the same billing NPI or TIN, the same plan or issuer, a similar condition under one of three grouping paths, and one 30 business day period. A batch holds up to 50 items.

Written by Salman Saeed, CEO and Co-Founder · Reviewed by a Certified Medical Coder · Published October 26, 2026

Anesthesia billing team sorting out-of-network claim lines into groups for IDR batching — Sort by TIN, payer, grouping path and window, then cap at 50.

In short: sort your claim list by NPI or TIN, then by the plan that must pay, then by grouping path and 30 business day window, and cap each batch at 50. The 50 line item cap applies when open negotiation starts on or after November 1, 2026.

What four tests must a batch pass?

A batch must pass four tests in 45 CFR 149.510(c)(4)(i)(A) through (D): the same billing provider, the same payer, a similar condition, and the same 30 business day period. Fail one test and the item leaves the batch.

The definitions and fee rules are on the batching claims page. This post is the sorting method you run on your own claim list, in the order that removes the most items first.

Test	The question to ask of each line	Where the answer is
(A) Same billing provider	Was it billed with the same NPI or TIN as the others?	The billing NPI and TIN on the claim
(B) Same payer	Is the same issuer, or the same self-insured plan, required to pay?	The plan on the remittance, not just the payer name
(C) Similar condition	Does it fit one of the three grouping paths?	The service code, patient and claim form
(D) Same window	Were all items furnished within 30 business days of the first one, and did each open negotiation period end within 4 business days of IDR initiation?	Dates of service and your open negotiation log

How do you sort a claim list into batches, step by step?

Export the unpaid out-of-network lines

Pull every line you intend to dispute with the billing NPI or TIN, payer, plan, service code, date of service and the date open negotiation started.

Split by billing NPI or TIN

The rule treats items as billed by the same provider or facility if they carry the same NPI or TIN. Lines under two TINs are two lists.

Split by the entity that must pay

For a fully insured plan, the same issuer works even across different group policies. For a self-insured plan, the same plan works, including through a third party administrator. Two self-insured plans do not, even if one TPA pays both.

Assign a grouping path

Mark each line as one patient in one encounter, the same service code (or a comparable code), or, for anesthesiology, radiology, pathology and laboratory items, the same Category I CPT code range in guidance the Secretary publishes. Read that guidance for the ranges before you rely on this path.

Cut to 30 business day windows

Within each group, start at the earliest date of service and keep only the lines furnished within 30 business days of it. Use the NSA deadline calculator to count.

Cap each batch at 50

A certified IDR entity may consider up to 50 qualified IDR items and services jointly. Anything left over forms another batch, if it still passes the tests, or a single dispute.

Check open negotiation timing

Every item needs its own 30 business day open negotiation period that ended within 4 business days of IDR initiation. Start the periods for the items in one batch together so they end together.

What does a sorted list look like?

Example (illustrative, made-up counts)

An anesthesia group billing under one TIN has 80 unpaid out-of-network lines. It assumes all lines fall in one grouping path. The sort gives five disputes.

Issuer A, first 30-business-day window, 58 linesBatch 1 of 50 lines, plus batch 2 of 8 lines

Issuer A, later window, 8 linesBatch 3 of 8 lines

Two self-insured plans paid by the same TPA, 14 lines (7 each)Two separate disputes of 7 lines each

Total80 lines in 5 disputes

The TPA lines look like one payer, but the rule says paying through the same third party administrator does not make two self-insured plans the same payer. Check the plan name on the remittance. The anesthesia billing page covers the claim side.

Which batching rules apply to my dispute today?

The 50 line item cap and the new batching cooling-off rule apply when the open negotiation period starts on or after November 1, 2026. CMS said so in its August 3, 2026 notice, and it repeated it in an October 2, 2026 notice. Batched disputes with an earlier open negotiation start stay under the 90-calendar-day cooling-off period.

After a batched determination, the party that started the dispute may not start another against the same other party for the same items or services for 30 business days under 149.510(c)(5)(vii)(B). After a single determination the wait is 90 calendar days. The IDR operations rule page tracks what else changed.

Which batching mistakes get a dispute sent back?

CMS lists "Incorrectly batching or bundling multiple items or services" as a common mistake on its tips page. It also says parties can upload an email from a certified IDR entity asking for a resubmission with batching corrections.

Mistake	Why it fails	Fix
Mixing two TINs in one batch	Test (A) needs the same NPI or TIN	Split the list by TIN before anything else
Treating two self-insured plans as one payer	Test (B) fails even with a common TPA	Batch by plan, not by TPA
More than 50 lines	The entity may consider up to 50 items jointly	Start a second batch
Lines from different months	Test (D) needs one 30 business day period	Split by window
Open negotiation periods that end on different days	Test (D) needs each period to end within 4 business days of IDR initiation	Start negotiation for a batch's items together

Items that qualify under the DRG-style bundled payment definition in 45 CFR 149.30 follow a different path, one payment determination at the single determination fee. The batching page covers it.

What does a batch cost compared with single disputes?

A batch pays one certified IDR entity fee for batched determinations, which the rule limits to a range of $268 to $1,173 for disputes initiated on or after January 22, 2024, plus a tiered fee of $75 to $250 for each additional 25 line items starting with the 26th. A single determination fee range is $200 to $840 (149.510(e)(2)(viii)).

The administrative fee is $15 per party per dispute for disputes initiated on or after June 11, 2026. Our fees post shows the totals side by side.

How Nucleus Align handles batching

For out-of-network billing and IDR clients, we run the sort, deadline management and documentation validation before any dispute submission. Book a call to review a claim list, or browse the blog.

Sources

45 CFR 149.510 Independent dispute resolution process · eCFR
No Surprises Act notices and guidance · CMS
Tips for disputing parties · CMS
Federal IDR operations final rule, 91 FR 33900 · Federal Register

We check every rule, code and deadline against the official source. See our editorial policy.

Written by Salman Saeed, CEO and Co-Founder

Reviewed by a Certified Medical Coder. Our editorial policy explains how every article is checked.

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01Which claims can be batched in one IDR dispute?

Items billed with the same NPI or TIN, payable by the same plan or issuer, grouped under one of three similar-condition paths, and furnished within one 30 business day period (45 CFR 149.510(c)(4)(i)). A batch holds up to 50 items. Anything that fails a test goes in another dispute.

02Can I batch claims from two different payers?

No. Payment must be required from the same group health plan or health insurance issuer. A fully insured issuer can cover different group policies, but two self-insured plans cannot be batched together, even if one third party administrator pays both (149.510(c)(4)(i)(B)).

03How many line items can go in one batch?

Up to 50. Under 149.510(c)(4)(i) a certified IDR entity may consider up to 50 qualified items and services jointly. The cap applies to disputes with open negotiation periods that begin on or after November 1, 2026. Items beyond 50 need another dispute.

04Is a DRG claim batched or bundled?

A DRG is the rule's own example of a bundled payment arrangement under 45 CFR 149.30: one service code covering multiple items for one patient. Bundled items get a single payment determination at the single determination fee under 149.510(c)(4)(ii), not a batch.