The No Surprises Act made IDR complex. We made it manageable.

The challenge

The federal Independent Dispute Resolution process is deadline-driven, high-volume, and unforgiving of error. Manual approaches don’t scale and expose payers to avoidable risk.

Our solution

We designed and built the case-management solution a healthcare payer uses to run the federal IDR process end to end: eligibility screening, deadline and state tracking, offer preparation, and documentation. We continue to provide the regulatory advisory and specialized resources that support that process on an ongoing basis. The platform we license to other payers is built directly on that same proven design, pairing a deterministic engine that governs deadlines and state with AI-assisted intake for the document-heavy first mile. The result: fewer missed deadlines, stronger offers, and a defensible audit trail.

Proven in production

Our IDR solution isn’t a concept. The design behind it runs in production today at a healthcare payer processing disputes at volume, and the results there are a representative example of the improvement the approach can drive.

The clearest signal: that payer’s win rate climbed from 2% to 34% over roughly two years, rising steadily and moving well above payer industry averages. (For how payer win rates behave against the Qualifying Payment Amount, see our analysis in Winning the IDR Battle.) The same engagement avoided roughly $1.0M in cost over a single six-month period by catching IDR-ineligible disputes before they reached arbitration, and kept submissions on time across every stage of the process.

Every payer starts from a different place, so the lift varies with your starting win rate, case mix, and dispute volume. What this engagement shows is the magnitude of improvement the approach can produce, and that the software and methodology behind it are proven in a live, high-volume environment, not just on paper.