In a recent win for health care providers, Indiana has enacted Senate Enrolled Act No. 189, a new law addressing certain disputes arising under the federal Independent Dispute Resolution (“IDR”) process established by the No Surprises Act (“NSA”). The legislation passed the Indiana General Assembly with unanimous bipartisan support (49-0 in the Indiana Senate and 96-0 in the Indiana House of Representatives) and restricts health carriers from imposing administrative penalties on facilities or providers related to care involving out-of-network clinicians while also establishing procedural requirements for high-volume IDR disputes.
A copy of the enacted legislation is available here .
Background on the No Surprises Act
The NSA, enacted in December 2020 and effective January 1, 2022, prohibits providers from issuing balance bills to patients for certain out-of-network services, including emergency services and certain services furnished at in-network facilities. Under the NSA, patients are typically responsible only for the in-network cost-sharing amounts they would have paid had the services been rendered in-network. Meanwhile, payment disputes between out-of-network providers and payers are resolved through negotiation or an IDR arbitration process. Because these provisions have altered the dynamics of payment negotiations between providers and payers, the NSA has generated a substantial number of payment disputes between out-of-network providers and health plans. In response, policymakers in several states have begun examining how these disputes are affecting health care markets and payer-provider relationships. Indiana’s new law represents one of the first state efforts to address operational issues arising from high volumes of federal IDR filings.
Increased Protections for Out-of-Network Providers
Most notably, Indiana’s new law includes a provider-friendly provision that appears squarely aimed at a developing category of payer practices – most prominently, Anthem’s recently announced policy imposing a 10% payment reduction on certain facility claims involving out-of-network clinicians. These policies have drawn significant scrutiny from providers and policymakers as an effort to shift reimbursement risk onto facilities and indirectly discourage lawful out-of-network care arrangements. In direct response, the Indiana statute prohibits health carriers from assessing administrative fees, penalties, or other financial disincentives against a facility or provider based on the involvement of an out-of-network clinician in the delivery of covered services. By doing so, the law effectively forecloses the type of reimbursement reduction approach reflected in Anthem’s policy.
Indiana’s approach reinforces the core structure of the NSA, which contemplates that payment disputes should be resolved through negotiation and the federal IDR process (not through unilateral, payer-imposed financial pressure). The law further strengthens this protection by classifying violations as unfair and deceptive acts in the business of insurance, exposing non-compliant carriers to regulatory enforcement and potential penalties. In practical terms, this creates both a clear substantive prohibition on Anthem-style reimbursement reductions and a meaningful enforcement mechanism for providers and facilities navigating the post-NSA landscape.
Additional Administrative Provisions of the Indiana Law
In addition to expanding protections for out-of-network providers, Indiana’s new law establishes state-level procedures governing certain administrative aspects of disputes submitted through the federal process. While the statute does not alter the federal arbitration framework, it increases transparency and promotes resolution in cases involving high volumes of disputes. Among other requirements, a party initiating IDR must provide written notice to the facility within three business days, including a copy of the federal IDR initiation form. Failure to comply may result in enforcement action by state regulators, including potential disciplinary action and oversight measures.
The law also creates a process for situations involving twenty-five or more IDR disputes. In such cases, carriers may require providers to participate in a good-faith negotiation process, including at least one conference and an exchange of relevant information, to be completed within thirty days. This process does not resolve individual claims or affect a party’s rights under federal law, but it is intended to facilitate broader dispute resolution. Following the conference, the parties must submit a memorandum of conference to the Indiana Department of Insurance summarizing the disputes and including certain claim-level payment data (e.g., initial payment, offers, requested amounts, and QPA). While the Department may publish aggregated data, claim-specific information remains confidential.
What’s Up Next? Potential Implications for Providers
Indiana’s new law reflects growing state attention to the operational effects of the federal IDR system and the increasing volume of arbitration disputes arising under the NSA. While the Indiana law does not alter the federal IDR framework itself, it introduces new procedural obligations for parties filing large numbers of disputes. The legislation also appears to respond to emerging payer strategies aimed at discouraging the use of out-of-network clinicians at in-network facilities. Thus, as the NSA continues to reshape payment negotiations between providers and health plans, additional states may consider similar legislative measures addressing both the growing volume of IDR disputes and payer strategies affecting network participation. Providers should, accordingly, monitor developing state law protections applicable to surprise billing matters and incorporate these new protections into their IDR strategies.
HaloMD is actively monitoring developments related to the No Surprises Act and its implementation. For additional insights into this and related regulatory developments, visit our News & Resources page.