Out-of-network emergency, anesthesia, radiology, and surgical claims are routinely paid at the insurer's benchmark rate. Federal IDR exists to fix that — providers prevail in roughly 85% of decided disputes. Most groups still don't file. We do it for you, end to end.
Providers won 85–88% of IDR determinations in 2025 · ~$15B awarded through IDR in 2025 · Fees only on the uplift we secure
Every eligible claim has a 30-day open negotiation window, then a 4-business-day window to initiate the dispute, then batching rules, eligibility review, fee deadlines, and offer submission. Billing teams built for in-network claims rarely have the process to run it at volume.
We audit your OON remits, flag every claim that qualifies for federal IDR (or a state process), and separate them from the ones that don't — so you never pay to file an ineligible dispute.
Open negotiation notices, initiation filings, batching, IDR entity selection, administrative and entity fees, offer submission. Tracked per claim, per payer, per clock.
Baseball-style arbitration means the arbiter picks one number. We price offers off actual determination data by specialty, code, and market, and support them with the evidence arbiters credit.
The qualifying payment amount (QPA) is the insurer's median in-network rate — and it's usually the opening offer. Median IDR awards in the second half of 2025, as a multiple of QPA:
Source: CMS Federal IDR public use files and supplemental tables, Q3–Q4 2025. Medians vary by code, market, and payer; see our IDR data page.
Over half of all IDR disputes. Facility and professional claims, high volume, batchable.
Hospital-based, out-of-network by structure, and consistently underpaid at QPA.
Second-largest dispute category. Reads across facilities create batching opportunities.
Lower volume, highest multiples — surgical medians exceeded 12× QPA in late 2025.
Small dispute counts, the highest award ratios in the program.
Separate rules, separate batching. We handle both.
You already received the payer's initial payment. Our fee is a percentage of the additional amount recovered through negotiation or IDR determination — nothing on what you already had, and nothing if we don't improve it. Dispute filing fees are pass-through and disclosed up front.
We work inside your existing billing system or ours. Your team keeps posting payments; ours takes every OON claim from the moment it's underpaid to the moment the determination is paid — including chasing payers who miss the 30-day payment deadline after an award.
No. Federal IDR is an administrative process run through the CMS portal, and providers routinely use billing companies or dedicated filing services to run it. Complex disputes may benefit from counsel; we'll tell you when.
Out-of-network emergency services, non-emergency services by OON providers at in-network facilities, and air ambulance — under plans subject to the No Surprises Act — where the state doesn't have its own applicable surprise-billing law. Eligibility rules changed under the 2026 operations rule; we screen every claim against current criteria.
Those specific claims can't be filed. But most groups have a continuous stream of new underpaid OON claims, and the 90-day cooling-off and batching rules make it worth setting up correctly now.
Most determinations now issue within 30–60 business days of initiation, and payers owe payment within 30 days of the decision. Late payment is common; follow-up and CMS complaints are part of our service.
Send us a sample of recent OON remits. We'll tell you which claims are IDR-eligible, what similar disputes have paid, and what we'd file. No fee unless we win you more.
Request a free eligibility review