Improving IDR Dispute Processing & Automation

Challenge

After the No Surprises Act passed, our Client’s team faced a surge of Independent Dispute Resolution (IDR) requests, dispute email volumes approaching 12,000 per month. That volume, plus the financial exposure of duplicate or abusive dispute submissions, demanded an urgent overhaul. They asked Trexin to assess the process and recommend the people, tools, and roles to manage and improve IDR dispute processing.

Approach

A three-week assessment (stakeholder interviews, workflow documentation, and process diagnostics) produced actionable recommendations. We then led a four-week planning and execution jump-start to implement them, focusing on data accessibility and centralization and mapping all IDR documentation for future automation. Execution prioritized backlog resolution and the groundwork for automation.

Outcome

• Structured oversight and detailed tracking let the Client act decisively at every stage
• Overall win rate increased, with some periods as high as 32% for the payer
• Real-time visibility let stakeholders withdraw losing disputes before incurring arbitration costs: the withdrawal process alone saved $900k over nine months (~$100k/month)
• Trexin project-managed the move toward automation, producing faster resolutions and fewer lost opportunities

Why Trexin

We pair regulatory understanding with execution, turning an unmanageable inbox into a defensible, data-driven process.