Since the No Surprises Act, the only way to contest a low payer payment is the federal IDR process. Most independent groups don't have the staff to work it claim by claim, so they take the underpayment. This service does the work, at volume, and is paid only on what it recovers.
Most of the value in a first call is telling you quickly whether this applies to you. Here is the short version.
Under the No Surprises Act, when a payer pays an out-of-network claim below what it's worth, you can't balance-bill the patient anymore. Your remedy is open negotiation with the payer and then the federal independent dispute resolution process, where a certified arbitrator picks one side's number. Providers win the large majority of those decisions, and the awards run well above the payer's qualifying payment amount. The money is there.
The catch is the work. Every claim has to be screened for eligibility, batched correctly, filed inside strict windows, argued and tracked to payment. A billing department that is already stretched doesn't do that at scale, and the payers know it. So the underpayments stand, month after month.
The 2026 IDR rule made filing cheaper: the administrative fee dropped from $115 to $15 per party per dispute for disputes initiated on or after June 11, 2026. Starting November 1, 2026, radiology, anesthesiology, pathology and laboratory claims can be batched by CPT code section, with a 50 line-item cap. The rule also removes the option to resubmit a dispute that was batched incorrectly, so a batch you get wrong stops being a do-over and becomes a lost claim. Cheaper to file, less forgiving to file badly. That is an argument for doing it with software and people who do nothing else.
You send data once. The service takes it from there and reports back on every case, with an audit trail on each one.
Your 835 and 837 files are ingested straight from the clearinghouse. No manual claim pulls, nothing for your staff to build.
Every candidate claim is scored for eligibility and expected value before anything is filed, so you are not paying arbitration fees on disputes that go nowhere.
Open negotiation with the payer, then IDR submission with the batching logic kept current as the Departments issue guidance. Deadlines tracked on every case.
Post-determination payment tracking and escalation until the money lands, then reporting on net lift, automation rate, ineligible rate and days to cash.
The fee is contingent on collections, so the group carries no cost to start and no cost on a claim that doesn't pay. Arbitration entity fees are paid by the non-prevailing party under the federal rules, which is exactly why the eligibility screen matters: it keeps you out of disputes you would lose.
IDR is the process Congress built for exactly this dispute, and payers are on the other side of tens of thousands of these cases a month. Filing well-screened claims through it is normal revenue-cycle practice, not an act of war. What does damage a relationship is filing ineligible claims, which is what the screen prevents.
Setup is two to four weeks once the 835 feed is in place. After that, timing depends on the negotiation and arbitration windows for each claim, so the first determinations land in the following months. The pilot is 90 days so you can measure days to cash on your own claims rather than take anyone's word for it.
Publicly, providers have prevailed in roughly 85% of federal IDR determinations through the most recent period CMS has reported, and the median award to a prevailing provider ran about 445% of the qualifying payment amount in 2024. Those are national figures across all specialties. Your results depend on your claim mix, payers and eligibility, and no group is promised a number.
Yes. The service sits alongside an existing RCM workflow and only needs the remittance data. Your billing team keeps doing what it does.
Some groups do, and it works at small volume. At scale it becomes a full-time job of tracking deadlines, batching rules and payer behavior across hundreds of disputes, and the 2026 rule makes a batching mistake unrecoverable. Automation carries the volume so scaling across sites doesn't mean adding headcount.
Bring your specialty, your payer mix and a rough sense of your out-of-network volume. I'll tell you plainly whether a pilot makes sense and what it would take to start.