The federal No Surprises Act protects patients from balance billing in specific situations. For providers, it also created a federal arbitration process called Independent Dispute Resolution. When carriers underpay the Qualifying Payment Amount, providers have the right to pursue full reimbursement through IDR. We handle the process from initial dispute through final resolution.
The No Surprises Act is a federal law that took effect in 2022. It protects patients from unexpected medical bills when they receive out-of-network care in specific situations. This includes emergency services, ancillary services like anesthesia, and certain non-emergency care provided by out-of-network providers at in-network facilities.
For providers, the law fundamentally changed how out-of-network services in these categories are reimbursed. Carriers issue an initial payment based on the Qualifying Payment Amount, a figure that’s supposed to reflect median in-network rates. In practice, the QPA is often significantly lower than reasonable reimbursement.
If a provider does not challenge the QPA payment through the formal dispute process, that initial payment is typically all they receive.
If you provide out-of-network services covered under the No Surprises Act, including emergency care, ancillary services, or non-emergency care at in-network facilities, and the carrier’s payment falls short of fair reimbursement, you have the right to pursue recovery through federal IDR arbitration.
After receiving the carrier’s initial QPA payment, the provider has 30 business days to initiate an open negotiation period. The provider submits a dispute to the carrier with documentation supporting a higher reimbursement amount. We prepare this initial demand and manage all communication with the carrier.
If the carrier and provider cannot resolve the dispute during open negotiation, the provider has the right to file for federal IDR. The case is submitted through the federal IDR portal to a certified IDR entity. We prepare the arbitration submission, build the supporting evidence package, and argue the case.
The IDR entity selects either the carrier’s offer or the provider’s offer through a process called baseball-style arbitration. The decision is binding.
Carriers know the rules. They use the technical complexity of the IDR process to dismiss provider claims on procedural grounds.
NSA IDR is federal. Some states also have their own surprise bill arbitration systems. Submitting to the wrong forum invalidates the filing.
The NSA process has multiple strict timeframes. 30 business days to initiate negotiation. 4 days to file IDR after negotiation ends. A missed deadline ends the case.
Incomplete forms, missing documentation, incorrect party designations. Carriers use any technical error as grounds for dismissal.
Carriers challenge whether the service is even subject to NSA, hoping to push the dispute outside the arbitration system entirely.
Even when providers win, some carriers fail to pay binding IDR awards. Enforcement requires state and federal litigation.
For medical providers that already work with us on No-Fault PIP claims, NSA representation is a natural extension. Same team. Same client service. Same operating principles.
For providers who are new to working with us, we offer the same straightforward approach we’ve built over more than two decades representing medical providers. We handle each case from initial dispute through final resolution. Real-time visibility into where every claim stands. Personal communication, not automated updates.
Note: Fee structure for NSA cases is tailored to the specifics of the engagement. Contact us to discuss.
We’ve spent more than two decades fighting carriers to recover what medical providers are owed. NSA is a new statutory framework, but the work is the same: building strong cases, navigating procedural complexity, and holding carriers accountable to pay fair reimbursement.
Schedule a free consultation. We can meet at your office or virtually.
