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FEDERAL ARBITRATION SERVICES & RECOVERY
Recover More From Eligible Out-of-Network Claims
Medical providers can face persistent underpayments, disputed reimbursement, and denied out-of-network claims. Our Federal Arbitration Services & Recovery support is designed to help eligible providers review disputed claims, prepare the required documentation, navigate the applicable Independent Dispute Resolution (IDR) process, and track payment through resolution.
----- INTRODUCTION
What Are Federal Arbitration Services & Recovery?
Federal arbitration under the No Surprises Act provides a structured process for resolving certain payment disputes between eligible healthcare providers and health plans. When a qualifying dispute is not resolved during the required open negotiation period, the matter may proceed to the applicable Federal Independent Dispute Resolution process.
Our support can cover claim review, eligibility assessment, documentation preparation, payment-position development, submission support, deadline tracking, determination monitoring, and payment follow-up.
Structured Recovery Support
● Claim Review & Eligibility Assessment● Open Negotiation Timeline Management● Evidence Compilation & File Submission● Binding IDR Determination & Reconciliation
---- REVENUE PROTECTIONS
Why Providers Need a Structured Recovery Process
Managing disputed out-of-network claims demands operational discipline, deep statutory understanding, and strict adherence to mandatory federal and state timelines.
Revenue Leakage
Underpaid out-of-network claims can create recurring revenue leakage.
Eligibility & Routing
Eligibility and dispute-routing requirements can vary depending on the claim and applicable state or federal framework.
Evidence & Timelines
IDR submissions require organized evidence and attention to required timelines.
High Dispute Volume
Internal billing teams may not have the capacity to manage high volumes of complex disputes.
Follow-Through
Payment recovery requires follow-through after a determination, including monitoring and reconciliation.
---- CORE CAPABILITIES
Our Federal Arbitration Services
Comprehensive support services structured to guide qualifying out-of-network claims
from initial assessment through resolution and payment recovery.
Claim Review & Eligibility Assessment
We review disputed payment claims to determine whether they may qualify for the applicable federal IDR pathway. The review considers the service, payer or plan type, location, and other applicable requirements.
Open Negotiation Support
Qualifying federal disputes generally require an open negotiation stage before IDR. We help organize the claim information and reimbursement position for this stage and track the applicable timeline.
Content Documentation & Evidence Preparation
A strong dispute file should clearly present the provider's position. Supporting material may include claim information, medical records, coding details, clinical documentation, payment information, service complexity, and relevant reimbursement or market information.
Payment Offer Preparation
We help organize the provider's payment position and supporting evidence for submission through the applicable dispute-resolution process.
Federal IDR Submission Support
Once a dispute is ready for IDR, the submission must follow the applicable process and deadlines. Our workflow is designed to keep documentation organized and submissions on track.
Determination Tracking & Payment Follow-Up
Recovery does not necessarily end when a determination is issued. We support tracking the outcome, monitoring payment, and maintaining records through resolution.
JURISDICTIONAL ROUTING
Federal vs. State Dispute Resolution
Not every out-of-network payment dispute follows the same route. Federal IDR may apply to qualifying claims governed by the No Surprises Act, while certain states have their own applicable dispute-resolution systems. The correct pathway depends on factors such as the service, payer or plan, state requirements, and the applicable legal framework.
Out-of-network emergency services
Certain out-of-network services provided at in-network facilities
Air ambulance services
State-specific dispute systems where applicable
Our Process
What Information May Be Needed
Preparing a comprehensive claim file helps establish a clear and supported reimbursement position.
Claim and payment information
Information demonstrating service complexity
Heading: Explanation of Benefits or Payer Response
Provider and facility information
Relevant medical or clinical documentation
Applicable reimbursement or market information