Dive Brief:
- The Trump administration has certified a new arbiter to decide out-of-network payment disputes between providers and insurers through the process set up by the No Surprises Act.
- Physio Solutions, which does business as Medlitix, is an independent review organization that provides medical and peer reviews, as well as dispute resolution services to health plans, pharmacy benefit managers, third-party administrators and over 40 government programs.
- The new addition brings the total number of certified arbiters to 17, as disputes in the independent dispute resolution, or IDR, process continue to snowball.
Dive Insight:
The No Surprises Act went into effect in 2022 to protect patients from unexpected out-of-network medical bills. To do so, the law set up an arbitration process to resolve payment disputes when payers and providers can’t agree on reimbursement, which includes companies authorized by the federal government to settle payment disputes.
But the federal IDR process has faced a much higher volume of disputes than the government expected.
Payers and providers submitted 1.4 million disputes through the IDR process during the second half of 2025 alone, 16% more compared to the first six months of the year, according to the latest federal data.
The deluge has led to backlogs in cases, which the federal government has attempted to solve in part by adding additional arbiters to process more disputes: Four new companies, including Medlitix, have been added since June 2025, expanding the total number of arbiters from 13 to 17.
CMS officials said that adding new certified IDR entities like Medlitix will help make the dispute process more efficient and accountable. Although officially certified, Medlitix is not currently accepting new disputes. Neither the company nor the CMS responded to a request for comment on when Medlitix will begin accepting disputes.
Medlitix joins the list of certified IDR entities as they themselves are being increasingly scrutinized.
Earlier this month, Rep. Frank Pallone, D-N.J., a member of the House Energy and Commerce Committee, announced he was investigating some of the arbiters, sending letters to six companies requesting documents and asking questions about how they make claims decisions. Pallone expressed concerns that the process is not functioning as Congress intended amid the skyrocketing case volume.
The letter followed a report from Georgetown University that found some arbiters who more frequently rule in favor of providers also grant larger payouts in disputes. Although providers disputed the report, researchers said that the findings suggest providers might select arbiters who more frequently rule in their favor, which could be driving spending.
Payers themselves have criticized the federal IDR process for allowing too many ineligible disputes to enter the system, resulting in the bloated volume of claims and inappropriate payouts for providers.
