No Surprises Act Open Negotiation Period (ONP): How Providers Avoid Missed Deadlines and Lost Revenue

When the No Surprises Act first took effect, it was designed to protect patients from unexpected medical bills. But for healthcare providers, it quickly introduced a mountain of administrative and financial pressure.

Let’s be completely honest: navigating the NSA process has become an operational obstacle course. At the start of this maze sits the Open Negotiation Period (ONP), which should be a critical, 30-business-day sprint where out-of-network revenue is either successfully recovered or written off entirely.

Unfortunately, as you have likely already experienced, many payers treat the ONP as a minor procedural formality to be ignored, frequently bypassing meaningful negotiation entirely.

With the CMS Operations Final Rule that came out in May 2026, the ONP process was placed in the spotlight: initiating the 30-business-day open negotiation period will require a formal submission through the Federal IDR portal, with the clock starting the exact business day you hit submit.  After that, the payer will be legally required to issue a formal response notice by business day 15.

If the payers ignore this or if they negotiate in bad faith?  You will have  an auditable trail of concrete, portal-verified evidence to shape your arbitration outcomes during the subsequent IDR phase.

To leverage this upcoming new level of payer accountability, your internal operations must be airtight. Stuck manually drafting notifications or tracking disjointed emails and deadlines in spreadsheets? In-house automation is how your team can keep from missing these critical deadlines and updates.  Curious about outsourcing?  Take a look at my Outsourcing vs. Software blog.

A successful automation manages the Open Negotiation Period through four core capabilities:

1. Automated Document Ingestion: automatically ingest time-critical emails from payers, extract data from attachments, and route tasks to the appropriate team members.  This may be less needed once the portal is open, but it is difficult to say until the portal is available.
2. Template Population: Instead of manually drafting CMS paperwork for individual claims, the automation should auto-populate required notices and prepare portal-ready files using existing billing data.
3. Timeline Monitoring: the solution should automatically track the 30-day ONP timeline and flag instances where a payer has missed their mandatory 15-day response notice.
4. Direct Escalation to IDR: If negotiations fail to yield a fair resolution within 30 days, the solution should automatically initiate the IDR process, selecting an Independent Dispute Resolution Entity (IDRE) based on predefined business criteria, and generate formatted position statements.

Transitioning from manual tracking to an automated workflow directly impacts operational efficiency and revenue retention. Providers utilizing this structured automation approach have eliminated revenue loss caused by missed compliance windows, and have allowed their revenue cycle staff to re-focus on complex, high-value appeals while letting the automations take care of the rest.

There was two other critical updates: a reduction of the administrative fee to a predictable $15 flat fee, and clarity around batching. This makes automated high-volume processing even more important for pursuing low-balance claims that were previously written off. We have seen that this is particularly impactful for high-volume specialties such as emergency medicine, radiology, and anesthesiology.

As this Final Rule and the subsequent portal is opened, the Open Negotiation Period is no longer an informal procedural step that is sometimes skipped; it is a legally codified, portal-enforced gateway to revenue recovery. With automation, your team can be prepared to make the most of it.

Want to continue the discussion? Let's Talk