Out-of-network claims and No Surprises Act disputes
managed end to end
Underpaid out-of-network claims are a deadline problem as much as a coding problem. We're opening this service to a small number of practices first, so we can run each dispute with full attention.
Claim Review for NSA Applicability
We check which underpaid claims fall under No Surprises Act protections, which do not, and which are worth pursuing.
Open Negotiation
We start the open negotiation period on time and document each offer, response and date, because the clock is unforgiving.
Federal IDR Filing
If negotiation fails, we prepare and file the independent dispute resolution request inside the required window and handle the administrative steps.
Offer and Evidence Packages
We assemble the case: the service, the provider's credentials and experience, the payer's qualifying payment amount and comparable payment data.
Deadline Tracking
Every dispute sits on a deadline tracker, with a named owner for each step, so nothing lapses.
Outcome Reporting
You see each dispute, the offers on both sides, the decision and the dollars paid, so you can judge the program on results.
Eligibility screen
We review the claim, the plan type and the payment to confirm the dispute path.
Open negotiation
We send the negotiation notice and pursue a settlement inside the federal open negotiation period.
IDR initiation
If there is no agreement, we file the dispute request inside the window and confirm the certified entity.
Evidence and offer
We submit the offer and the supporting evidence for the arbitrator.
Payment tracking
We track the payment from the payer, follow up on late payments and report the result.
- Facility-based specialties such as anesthesia, emergency medicine, radiology and pathology
- Ambulatory surgery centers with out-of-network exposure
- Practices whose out-of-network payments have dropped under No Surprises Act rules
- Groups that want one owner for every dispute deadline
Timelines above reflect the federal No Surprises Act process and can change. We confirm current requirements for each dispute.
Related reading and services: No Surprises Act billing 2026 · Payer contract negotiation · Revenue Recovery · Anesthesia billing.
Why most underpaid out-of-network claims never get disputed
Under the No Surprises Act, some out-of-network services (emergency care and certain non-emergency care at in-network facilities, among others) can be taken through a federal dispute process instead of the patient being balance billed. The process has real deadlines: a 30-business-day open negotiation period, then a short window to start independent dispute resolution.
Most practices miss it for a simple reason. Nobody owns the clock. The underpayment lands, it's coded as a contractual adjustment, and the window closes before anyone looks. Not every claim qualifies, and not every qualifying claim is worth the administrative fee, which is why an eligibility screen comes first.
We review each claim for applicability, run the negotiation on time and, when it fails, prepare and file the dispute. The decision to pursue each one stays with you.
How a dispute moves
- Day 1: Eligibility screenWe review the claim, plan type and payment to confirm whether the No Surprises Act applies and whether the dispute is worth filing.
- Days 1 to 30 (business days): Open negotiationWe send the negotiation notice and document every offer, response and date.
- Within 4 business days after negotiation: IDR initiationIf there's no agreement, we file the dispute request inside the required window.
- During IDR: Evidence and offerWe assemble the case: the service, provider credentials and experience, the qualifying payment amount and comparable payment data.
- After decision: Outcome reportYou see each dispute, both offers, the decision and the dollars paid.
How we price this pilot
This service is a limited pilot, so pricing is agreed with you in writing before we file anything. Structures vary with volume and claim value; we'll explain the options plainly and won't start work until you approve.
Federal IDR also carries administrative fees set by the government, which are separate from our service fee. We explain both before you commit.
Questions we hear most
Which claims are covered by the No Surprises Act?
Emergency services, certain non-emergency services from out-of-network providers at in-network facilities, and air ambulance services, for most group and individual health plans. Medicare, Medicaid and TRICARE are excluded.
What is the qualifying payment amount?
It's generally the plan's median in-network rate for the same service in your area, and it's one of the factors the IDR entity weighs.
Do you guarantee a result?
No. Dispute outcomes depend on the facts, the payer and the certified IDR entity. We show you the results on each dispute so you can judge the program yourself.
Is capacity limited?
Yes. This is a pilot for a small number of practices so each dispute gets full attention.
Related: No Surprises Act billing guide · Payer contracting · Aged A/R recovery · Free revenue assessment.
Have out-of-network claims that were underpaid?
Send us a few examples. We'll tell you whether they qualify for the federal process and what a dispute would involve.
Start With a Free Assessment →