NO SURPRISES ACT · FEDERAL IDR SUPPORT
The rules changed. Did your process?
For certain out-of-network payment disputes, federal Independent Dispute Resolution may offer a path forward. Insight Rev IQ starts with eligibility, deadlines, documentation and the financial merits of pursuing the dispute.
For provider organizations evaluating payment disputes. Eligibility and recovery are not guaranteed.
Founded by Kim Abrams, with more than 20 years in healthcare operations, revenue performance and payer strategy.
Eligibility comes before a submission.
A low payment or out-of-network status alone does not establish eligibility. The service, coverage, state rules and timing affect whether the federal process applies. We review those factors before recommending a federal IDR engagement.
Know what support you are engaging.
Eligibility and merits
Review the payment or denial information, relevant dates, applicable federal or state process, documentation and financial considerations.
Evidence and dispute support
The agreed scope may include review of the payer’s qualifying payment amount (QPA) information, offer strategy, evidence preparation, open-negotiation support, submissions and case tracking.
Payment reconciliation
Compare the determination with payment received, document unresolved amounts and follow up within the agreed scope. An award is not the same as collected revenue.
Understand the process before committing.
Federal IDR follows a required open-negotiation period. If the parties do not agree, an eligible dispute can proceed to a certified IDR entity, which decides between the submitted payment offers. Rev IQ supports the provider’s agreed work; the certified entity makes the determination.
We discuss service fees and applicable process costs before an engagement. Submitting an inquiry does not initiate a dispute or preserve a filing deadline.
Read CMS’s explanation of federal IDR →THE PEOPLE BEHIND THE WORK
Know who you are working with.
Insight Rev IQ was founded by Kim Abrams to give independent practices clearer revenue information and experienced executive interpretation. You can review our team, service details and educational articles before deciding whether to speak with us.
A few practical questions.
Does every out-of-network claim qualify?
No. Federal IDR applies to certain payment disputes under the No Surprises Act. Some disputes follow a state process or fall outside federal IDR. Eligibility must be assessed from the facts of the case.
Is IDR included in the revenue intelligence service?
IDR support is a separate engagement. We define responsibilities, documentation, deadlines and fees before work begins, including applicable dispute-process costs.
Can you guarantee an award or payment?
No. Eligibility, determinations, timing and payment depend on the facts and the applicable process. We distinguish potential value, an award and an actual payment.
What should I send first?
Start with your organization, contact information and a general description of the support needed. Do not submit patient information or claim documents through the website form. We agree on an appropriate document-transfer process if we proceed.
Tell us what support your organization needs.
We will follow up by email to discuss fit and the information needed for a review. Please keep your initial message general and leave out patient information and claim documents.