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---- NO SURPRISE ACT
Navigate the No Surprises Act With Confidence
The No Surprises Act changed how certain out-of-network healthcare payment disputes are handled. For eligible providers, the law created a structured process for addressing qualifying payment disputes with health plans while protecting patients from unexpected balance bills.
What Is the No Surprises Act?
A federal law protecting patients from certain unexpected out-of-network medical bills and establishing a dispute resolution framework for providers and health plans.
How It Affects Providers
We value each client and always respond to feedback throughout our cooperation.Changes reimbursement workflows, initial payments, and dispute processes for qualifying out-of-network services.
What Is IDR?
Independent Dispute Resolution (IDR) is a formal process to resolve certain payment disputes when negotiation isn't successful.
The No Surprises Act Dispute Process
A structured process designed to resolve qualifying payment disputes fairly and efficiently.
Initial Payment
The health plan issues an initial payment or payment determination for the qualifying out-of-network service.
Open Negotiation
The provider and health plan have an opportunity to negotiate the payment amount before initiating the IDR process.
IDR Initiation
If not resolved through negotiation, an eligible party may initiate the IDR process within the required timeframe.
Evidence Submission
The parties submit their payment positions and supporting information through the applicable process.
IDR Determination
A certified IDR entity reviews submissions and makes the applicable determination under the rules.
Payment Follow-Up
Track payment through completion and maintain records to monitor outstanding amounts and issues.
No Surprises Act Claim Review
Review potentially eligible out-of-network claims and organize the information needed to evaluate the appropriate reimbursement pathway.
IDR Documentation Support
Help assemble claim, payment, coding, clinical, and other relevant documentation required to present the provider's position clearly.
Technologies Payer Negotiation Support
Support structured communication and negotiation with payers when appropriate, with the goal of resolving eligible payment disputes before escalation.
Support Resolution Follow-Up
Monitor determinations and payments, identify unresolved issues, and help with follow-up to support accurate payment resolution.