Most out-of-network providers accept whatever the insurer pays because they don't know they can dispute it — or don't have the legal infrastructure to do so. We build that infrastructure for you, on contingency.
The federal Qualifying Payment Amount is a 2019 median contracted rate, indexed for inflation. Arbitrators have consistently found it understates actual market value — median awards now exceed 4× the QPA. Yet insurers pay it as though it's the ceiling.
The federal IDR process has a 4-business-day window to file after the 30-day negotiation period closes. Most small practices have no system to track this. Missed deadlines mean forfeited claims — permanently.
Baseball-style arbitration means the arbitrator picks one offer. Providers who win build comprehensive evidence packages: FAIR Health data, provider credentials, case complexity documentation, and prior payment history. Most practices submit none of this.
New York state IDR under Financial Services Law Article 6 and Insurance Law § 3241 has no fixed statutory filing deadline; practical filing window is approximately 2–3 years bounded by records/EOB retrievability, with up to six additional years available for parallel breach-of-contract litigation under CPLR § 213(2) for fully-insured plans. Claims written off in 2022 or 2023 may still be arbitrable under 23 NYCRR 400.
"A large percentage of out-of-network providers do not submit claims to arbitration and are, therefore, stuck with a fractional QPA payment. The insurance carriers know this and pay these providers peanuts."
— Minevich Law Group, healthcare reimbursement attorneys
Provider win rate in federal IDR disputes (CMS 2024 data)
Median award above insurer's QPA offer (Q4 2024)
Of IDR disputes are initiated by providers, not insurers
We handle the entire arbitration process so your billing staff doesn't have to. No upfront cost — we only get paid if you do.
We review your claim history to identify all disputes eligible for NY state IDR or federal NSA arbitration — including claims going back 3 years under New York law. Most practices discover significant recoverable revenue they didn't know existed.
We track all federal IDR filing windows (4 business days post-negotiation period) and NY IDR deadlines (3 years from original payment). We draft and submit all IDR initiation notices, select certified IDR entities strategically, and manage all correspondence with the CMS or DFS portal.
We build the evidentiary submission that wins arbitration: FAIR Health 80th percentile data for the specific CPT code and ZIP code, your credentials and board certifications, case complexity documentation from operative reports, and prior payment history with the disputing payer.
Baseball-style arbitration is won or lost on offer positioning. We calibrate your offer to be the "reasonable" one versus the payer's QPA-anchored offer. Offers too close to billed charges lose credibility; offers too close to QPA leave money on the table. We find the right number.
For practices with high claim volumes against the same payer, we batch multiple disputes into single IDR filings — dramatically reducing per-claim administrative cost and arbitration fees. This is the strategy used by the most successful high-volume IDR filers nationally.
IDR determinations are binding. If an insurer fails to pay within 30 days of determination, we pursue enforcement. We also handle reopening requests when an IDR entity has committed a procedural error — a right clarified by CMS guidance in 2025.
Every specialty has a different credible information framework. Here's what we focus on for the most common provider types we represent.
Anesthesiologists are defined as ancillary providers under 45 C.F.R. § 149.420(b)(1) and NY FSL § 603(h). You cannot obtain patient consent waivers. You cannot balance-bill. Your revenue recovery is entirely through IDR — which means every underpaid claim that goes undisputed is permanent revenue loss.
Brookings Institution analysis of NY IDR data identifies plastic surgeons as the single most frequent utilizer of NY state IDR. This includes both emergency/reconstructive procedures and elective procedures where the surgeon is OON at an in-network facility.
Radiology and pathology groups are among the most efficient IDR filers nationally because their claims are structurally similar and highly batchable. Radiology groups in particular have found significant success in the IDR process due to claim consistency and interpretable FAIR Health benchmarks.
ASC facility fees are separately disputable from physician fees. A single procedure may generate multiple eligible IDR claims: one from the surgeon, one from the anesthesiologist, and one from the facility. Each is independently arbitrable.
We represent providers on contingency. There is no upfront cost, no retainer, and no hourly billing. Our interests are aligned with yours.