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Out-of-network claims the payer thinks you will not fight

The No Surprises Act gave providers a real tool to contest lowball OON payments. Most practices never use it because the IDR process is opaque and technical. We run IDR and arbitration for you and recover what the payer owes.

Federal NSA IDR filings and responsesTexas PIP arbitration (personal injury protection)Commercial OON dispute resolution
Request a free audit Call (973) 699-6689
30 daysNSA IDR open negotiation window
90 daysstandard arbitration timeline
3x to 5xtypical recovery multiple over initial payer offer

What arbitration covers

Out-of-network payments are where payers most aggressively underpay. The No Surprises Act (NSA) created a federal Independent Dispute Resolution (IDR) process. Texas has a separate PIP arbitration process for auto-injury claims. Commercial plans often have internal OON dispute workflows that most practices never invoke. Every one is a lever to recover the difference between the QPA (qualifying payment amount) and the provider's billed rate.

Why most practices leave arbitration money on the table

The process has 30 and 90-day windows. The paperwork is technical. The QPA calculation and certified IDRE selection have real consequences. Most practices look at one underpaid claim and decide the filing fee is not worth it. But across a year of OON claims, the aggregate is usually six figures. We handle filings in volume so the economics work.

The No Surprises Act IDR process rewards preparation. A half-done submission loses. We run it like litigation, because that is what it is.

ASA Management playbook

What you need to file

  • Itemized bill with CPT and ICD-10 detail
  • EOB showing the underpayment
  • Medical records supporting medical necessity
  • Out-of-network status documentation
  • Notice of IDR initiation (for NSA) or arbitration demand (for PIP)
  • Provider credentials and practice documentation
Further reading

Where to go next

Pick a thread and keep pulling. Every engagement starts with the piece that has the biggest revenue leak.

ServiceA/R ManagementServiceDenial ManagementServiceRevenue Cycle ManagementSpecialtyOrthopedic Surgery BillingSpecialtyAnesthesiology BillingSpecialtyNeurology Billing
Are you attorneys?
No. IDR and arbitration are administrative processes that do not require counsel. We coordinate with your counsel when a case warrants legal escalation, but most disputes resolve inside the administrative framework.
What is the QPA?
The qualifying payment amount, calculated by the plan under NSA rules, usually the median in-network contracted rate for the service. Our IDR offers are benchmarked to the QPA with documentation supporting a higher amount based on acuity, complexity, or market comparables.
Which states do you file Texas PIP in?
Texas. The PIP arbitration venue is Texas. We file for providers treating Texas auto-injury patients regardless of the provider's state.
How is this priced?
Contingency based. Percentage of recovered differential. No recovery, no fee.
Start here

See the revenue leak before you sign anything.

A 30-day claim review, written findings, and a number. That is enough to decide.

Request a free audit Call (973) 699-6689
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