Legal challenges to the No Surprises Act (NSA) continue to arise with six lawsuits brought forth so far. One lawsuit challenging the constitutionality has failed, but challenges to the regulations used to enforce the statute have continued to erode timely decisions in the independent dispute resolution (IDR) process. Another is challenging the QPA methodology around ghost codes and $0.00 allowable rates used within the calculation. Arguments have been raised that the use these codes has or will result in provider reimbursement below Medicare. To date, two separate lawsuits filed by the same plaintiffs have successfully stopped or rewritten the process by which IDR entities can use the QPA. These lawsuits are just one example of the constant adjustments payers need to keep up with to be compliant. Managing NSA claims requires being vigilant about changes and having the flexibility, resources, and systems in place to make adjustments quickly and accurately.