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No surprise act & IDR services

An underpaid claim has a funny way of becoming a write-off when nobody bothers to question it.

Out-of-network claims subject to the No Surprises Act are frequently reimbursed at rates that fall far below the actual cost of care. Providers either accept that underpayment or lose the chance to challenge it, since IDR runs on strict timelines, eligibility criteria, and Qualifying Payment Amount estimates. Missing a single deadline can end the right to dispute the payment for good.

MedHeave’s reviews the reimbursement and opens negotiation with the payer before any deadline closes. When negotiation does not resolve it, we file the IDR submission with full supporting documentation and answer every payer rebuttal using the same QPA data the payer relied on. This process lets providers recover revenue that health plans expected them to write off permanently.

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Our operational footprint

These aren't aspirational targets.

These metrics are what we deliver, consistently, across all practices and specialties we work with.

75 to 85%

IDR success rate

70 to 80%

Charges recovered

100%

Deadline compliance

30-day

AR negotiation tracking

One compliance slip and you're not just losing the claim. You're inviting audits, penalties, and patient disputes.

Most providers know the No Surprises Act exists, but far fewer know which claims qualify, when its protections apply, or how the dispute process works. That gap between awareness and execution leaves underpaid out-of-network claims unresolved. The process is governed by strict eligibility rules and filing deadlines, and once those deadlines pass, the opportunity to recover revenue is gone.

MedHeave begins with a compliance assessment of your billing workflows, payer contracts, network status, and claim history to identify where NSA protections apply. Qualifying claims are validated using payer remark codes such as N830, N813, N858, and N877 before the appropriate compliance and reimbursement workflows begin. Good Faith Estimate requirements are managed for uninsured and self-pay patients, while Advanced Explanations of Benefits are coordinated for insured patients when required. 

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Where revenue slips

Someone’s biller is treating an initial remittance as a final settlement because auditing the numbers requires actual effort.

Revenue loss on out-of-network claims rarely comes from a single mistake. It hides inside reimbursement decisions that go unquestioned, unresolved, or simply accepted as normal. Without a structured dispute process, these recurring workflow gaps leave recoverable revenue behind.
Missed claim identification
Not every underpaid out-of-network claim qualifies for No Surprises Act protections, which makes accurate identification essential. Without a structured screening process, qualifying claims remain buried in remittance files instead of entering the dispute workflow. As a result, recoverable revenue is lost before the process even begins.
Expired filing deadlines
Every dispute is governed by strict federal timelines. Once the initial payment or denial is issued, the 30-business-day open negotiation period begins. If that window is missed, the opportunity to move into IDR becomes significantly narrower, leaving many eligible disputes unresolved.
Weak dispute documentation
A valid claim does not guarantee a successful IDR outcome. Supporting documentation must clearly justify the requested reimbursement through QPA analysis, market benchmarks, payment history, and clinical evidence. Without that foundation, even strong disputes can fail.
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We listen and we don’t judge.

30 minutes of this call can save you up to 25% of lost revenue.

In this session, we’ll walk you through
  • Revenue leakage indicators
  • Denial trends and root causes
  • AR performance observations
  • Immediate improvement opportunities
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