IDR Recovery
IDR Recovery. $0 Upfront. 90%+ Win Rate.
Out-of-network claims are not lost revenue. They are unrecovered revenue. Through the No Surprises Act's Independent Dispute Resolution process, we recover what payers owe, with no financial risk to your practice.
The Process
How We Recover Out-of-Network Revenue
Our AI-driven IDR process handles every step from claim identification through payment recovery, while our surgical billing expertise ensures evidence packages are built to win.
Claim Identification
Our AI scans every out-of-network claim to identify IDR-eligible disputes. We evaluate the qualifying payment amount (QPA) against the appropriate reimbursement rate to determine recovery potential.
Evidence Package Assembly
We build comprehensive evidence packages that include provider qualifications, procedure complexity, market rate data, patient acuity factors, and comparable reimbursement evidence that IDR entities weigh heavily in decisions.
IDR Entity Strategy
Not all IDR entities are created equal. Our system tracks entity decision patterns, win rates by payer and procedure, and selects the optimal certified IDR entity for each dispute based on historical outcomes.
Submission & Tracking
We handle all IDR submission logistics, deadline management, payer response tracking, and follow-up. Every case is monitored through resolution with automated escalation for stalled disputes.
Payment Recovery
Once a favorable decision is issued, we ensure the payer remits the awarded amount within required timelines. We track payment against the award and pursue collection on delayed payments.
QPA Intelligence
Why the QPA Shortchanges Surgical Providers
The qualifying payment amount is supposed to represent fair reimbursement. In practice, it systematically undervalues complex surgical services. Here is why.
QPA Manipulation
Payers often calculate the QPA using only contracted rates, which systematically undervalues out-of-network services. The QPA frequently does not reflect the true market rate for complex surgical procedures.
Information Asymmetry
Payers have access to their full claims data while providers typically lack comparative rate information. Our database of market rates and historical awards levels the playing field.
Complexity Undervaluation
Standard QPA calculations do not account for procedure complexity, patient acuity, provider training and experience, or the specialized equipment and staff required for complex surgical cases.
Regional Rate Disparities
QPAs derived from national contracted rate databases often fail to reflect regional market conditions, cost of living differences, and local supply-demand dynamics for specialized surgical services.
Our Model
Zero Risk. Full Recovery.
$0 Upfront
No retainers, no setup fees, no per-claim charges. You pay nothing until we recover additional payment through IDR.
Contingency Only
Our fee is a percentage of the incremental recovery, the amount above the payer's initial offer. If we do not win, you owe nothing.
Aligned Incentives
We only earn when you earn more. This means we are motivated to win the highest possible award on every single case.
Results
IDR Recovery by the Numbers
90%+
IDR Win Rate
Favorable decisions across all surgical specialties
$0
Upfront Cost
Pure contingency model with no fees until recovery
3.2x
Average Award vs QPA
Awards typically exceed the QPA by more than 3x
$2.8M
Average Annual Recovery
Per client IDR revenue recovered in year one
FAQ
Frequently Asked Questions
What is IDR and how does the No Surprises Act apply to out-of-network billing?
Independent Dispute Resolution (IDR) is a federal arbitration process created by the No Surprises Act that allows providers and payers to resolve payment disputes for out-of-network services. When a payer offers an initial payment that the provider considers inadequate, either party can initiate IDR. A certified IDR entity reviews evidence from both sides and selects one of the two submitted payment amounts. The process is designed to ensure providers receive fair reimbursement for emergency and certain non-emergency out-of-network services.
What does it cost to use Collective RCM for IDR recovery?
Nothing upfront. We operate on a pure contingency model for IDR services. You pay zero dollars until we successfully recover additional payment through the IDR process. Our fee is a percentage of the incremental recovery above what the payer initially offered. If we do not win the dispute or do not recover additional payment, you owe nothing. This completely eliminates financial risk for your practice.
How do you achieve a 90%+ win rate in IDR arbitration?
Three factors drive our win rate. First, our AI identifies the strongest cases for IDR submission, filtering out disputes unlikely to succeed. Second, we build evidence packages that directly address the factors IDR entities are required to consider: provider qualifications, complexity of service, market rates, patient acuity, and comparable provider rates. Third, we track IDR entity decision patterns and strategically select entities with favorable track records for each payer and procedure combination.
What types of claims qualify for IDR under the No Surprises Act?
The primary categories include emergency services provided by out-of-network providers, non-emergency services provided by out-of-network providers at in-network facilities (surprise billing scenarios), and air ambulance services. The claim must involve a payment dispute where the provider believes the payer's initial payment or QPA is inadequate. There are minimum dollar thresholds and specific timelines for initiating the IDR process that our team manages on your behalf.
How long does the IDR process take from start to resolution?
The typical IDR timeline is 60 to 90 days from initiation to decision. After the open negotiation period (30 business days), either party can initiate IDR. The certified IDR entity then has 30 business days to render a decision. Payment is due within 30 days of the decision. Our system manages all deadlines and accelerates the process wherever possible. We typically see full payment within 90 to 120 days of initiating the dispute.
Can you handle IDR for IONM, ASC facility fees, and surgical hospital services?
Yes. We handle IDR submissions across all surgical specialties and service types, including IONM professional and technical fees, ASC facility fees, surgical hospital facility charges, physician professional fees, and ancillary surgical services. Each service type requires different evidence strategies and market rate data, and our AI tailors the evidence package accordingly. Our surgical billing specialization means we have deep rate data and outcome history across these exact service categories.
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Your OON Claims Are Worth More Than You Think
Most surgical practices are leaving six to seven figures in out-of-network revenue unrecovered every year. Let us show you what your claims are actually worth.