How It Works
From Underpaid Remit to Recovered Payment
The No Surprises Act gives out-of-network providers a way to challenge low payments, but it runs on tight deadlines counted in business days. Your front desk forwards the claim. We handle routing, deadlines, negotiation and submission.
- 01
You forward the claim
Your front desk sends us the remittance or EOB for out-of-network claims that were underpaid or denied. That's the only step on your side. No new software, no portal to learn.
What we need: the remit or EOB, and the claim details your billing system already holds.
- 02
We check eligibility before anything is filed
We confirm each claim is a qualified item or service, that no valid patient consent waived protections, that the plan is covered, and whether it belongs in the federal process or a state one. Claims that won't succeed are screened out before any fee is spent.
The eligibility checklist - 03
We open negotiation with the payer
We send the open negotiation notice within 30 business days of the initial payment, with an offer we can support, and negotiate through the 30-business-day period. Many claims settle here.
How open negotiation works - 04
We file federal or state IDR
If negotiation doesn't settle the claim, we initiate IDR within the 4-business-day window, select the IDR entity, and batch claims where the rules allow. We cover the CMS and IDRE fees.
Every IDR deadline, step by step - 05
We build and submit the offer
Federal IDR is baseball-style: the arbitrator picks one offer or the other. We prepare the offer and supporting documentation around the factors an IDR entity is allowed to weigh, such as complexity, acuity, training and experience, and negotiation history, not just the payer's QPA.
Why the QPA isn't the final word - 06
We track the determination and the payment
The IDR entity rules within 30 business days of selection, and the payer then has 30 calendar days to pay. We track both deadlines and follow up until the money arrives. You get real-time case tracking and transparent reporting throughout.
What You Do
- Forward out-of-network remits and EOBs as they arrive
- Answer the occasional question about a specific claim
- Receive the recovered payments
What We Do
- Eligibility screening and federal vs. state routing
- Every deadline, counted in business days
- Open negotiation notices and payer negotiation
- IDR initiation, entity selection and batching
- Offer preparation and supporting documentation
- CMS and IDRE fees
- Determination and payment follow-up
You Pay Only When We Recover
A percentage of what we recover, with nothing upfront. If we lose, we absorb the costs, including CMS and IDRE fees.