Nothing upfront for our work. We are paid on contingency from what we recover. The fee depends on claim volume and age, and you get a clear number after the free audit.

No Surprises Act Underpayment & IDR Recovery for Facility-Based Groups

Q: Which claims qualify for federal IDR?

Out-of-network emergency services, and non-emergency services by out-of-network providers at in-network hospitals and ambulatory surgery centers. Some state-regulated plans use a state process instead; we sort that out during triage.

Q: What are the deadlines?

Open negotiation must start within 30 business days of the initial payment or denial and runs for 30 business days. IDR must then be initiated within 4 business days after negotiation ends.

Q: Can claims be batched?

Yes. Qualifying claims for the same or similar services under the same plan can be batched into one dispute, which lowers the cost per claim. We build batches to fit the rules.

Q: Do you work alongside our current billing company?

Yes. Your billing team keeps submitting claims. We take over the underpaid NSA claims after the initial payment.

Q: Does this apply to physical therapy or chiropractic?

Usually not. Office-based care falls outside the NSA’s out-of-network rules. Those practices recover underpayments through negotiation, appeals and state complaints instead.

For anesthesia, neurosurgery/spine, orthopedic, assistant-surgeon and neuromonitoring groups working out-of-network at in-network facilities, payers often pay near the QPA. Happy Billing runs open negotiation and federal IDR end to end, batching claims, on contingency.

Payers anchor on the QPA. The QPA is not the ceiling.

The qualifying payment amount (QPA) is the payer’s own median contracted rate for a service in your area. Under the No Surprises Act, payers often pay at or near it and wait to see who pushes back. Most groups don’t, because the negotiation and IDR deadlines are short and the paperwork is heavy.

The NSA covers out-of-network care at in-network hospitals and ambulatory surgery centers, and emergency services. It does not cover office-based out-of-network care such as physical therapy or chiropractic. Those practices should see out-of-network underpayment recovery.

Anesthesia

Anesthesia groups at in-network hospitals and ASCs are among the most frequent IDR filers. We batch qualifying claims to keep the cost per dispute low.

Neurosurgery and Spine

High-dollar procedures where the gap between the QPA and a fair rate is widest. We build the evidence case on complexity and training.

Orthopedics and Assistant Surgeons

Assistant-surgeon and co-surgeon claims are often paid on a fraction of an already-low QPA. We check the base rate and the reduction applied.

Intraoperative Neuromonitoring

IONM is often out-of-network at in-network facilities, so many cases fall under the NSA. We track each one through negotiation and IDR.

Who This Is For

Facility-Based Specialties

Anesthesia, neurosurgery and spine, orthopedics, assistant surgeons and intraoperative neuromonitoring.

Out-of-Network at In-Network Facilities

Services at in-network hospitals and ambulatory surgery centers, plus emergency care, where the No Surprises Act applies.

Not for Office-Based Care

Office-based PT, chiropractic and similar practices fall outside the NSA. Our out-of-network underpayment recovery service covers them.

Our Process, From Claim to Award

Claim Triage

We review your EOBs, confirm NSA eligibility, and flag every initial payment that sits at or near the QPA.

Open Negotiation

We start the 30-business-day open negotiation period with the payer. Many claims settle here.

IDR Initiation and Batching

If negotiation fails, we initiate federal IDR within the 4-business-day window and batch qualifying claims to lower the cost per claim.

Evidence and Awards

We submit evidence for a rate above the QPA, such as training, case complexity and prior contracted rates, then follow each award through to payment.

Contingency Fee. We Do the Work.

IDR takes real work: tracking deadlines, building batches, preparing evidence and following awards through to payment. We handle all of it and are paid on contingency from what we recover. Nothing is due upfront for our work.

The fee depends on claim volume and age. Start with a free underpayment audit and you get a clear number before anything is filed.

See how we approach frozen cash at facility-based groups in the $32M Recovery Blueprint case study.

Frequently Asked Questions

What is the QPA?

The qualifying payment amount is the payer’s median contracted rate for the same service in the same geographic area. Payers use it to set initial payments on NSA claims, but IDR entities weigh other evidence too and can award more.

Which claims qualify for federal IDR?

What are the deadlines?

Can claims be batched?

What does it cost?

Do you work alongside our current billing company?

Does this apply to physical therapy or chiropractic?

Is the QPA capping your collections?

Send us a sample of your NSA claims. We’ll show you which ones qualify and what they’re worth, at no cost.