Leading Out-Of-Network Ally
Let us handle the complexities of medical arbitrations, allowing you to focus on delivering exceptional healthcare. With our expertise, you can trust that the details are taken care of, so you can prioritize what matters most—your patients.
The No Surprises Act (NSA) was enacted in 2022 to protect patients from “surprise” bills for out-of-network care. Under the law, the amount a patient owes for out-of-network emergency care and non-emergency services delivered at in-network facilities cannot exceed the cost-sharing the patient would owe for similar in-network care. The law also created an independent dispute resolution (IDR) process to adjudicate disputes between insurers and providers over payment for affected out-of-network services. IDR is a binding final-offer arbitration process in which each party makes an offer and an arbitrator, called an “IDR entity,” chooses one of those offers to be the final payment amount.
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Under the NSA, after a relevant out-of-network service is delivered, the provider submits a claim and the insurer issues an initial payment (or denial of payment). If the provider is dissatisfied with the insurer’s payment, it may initiate a 30-day open negotiation period. At the conclusion of that period, either party may initiate IDR. In practice, the party initiating IDR is essentially always the provider.
When IDR is triggered, the parties may select an IDR entity by mutual agreement from the list of IDR entities certified by the federal government. If the parties cannot agree, then the federal government randomly selects an IDR entity from the list of certified entities. The IDR entity is charged with collecting evidence and payment offers from the parties and selecting one offer as the final payment amount.
What We Do
Our mission is to streamline the billing arbitration dispute process, maximize revenue, and reverse wrongful claim denials on behalf of healthcare providers.
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Unlike the competition, Med Arb Professional Solutions is unwavering in its aggressive approach in ensuring our clients claims are well-supported by our vast library of prior awards and archived paid EOBs.
Further, our client-centered business plan involves bi-weekly reports to keep each healthcare provider updated as to the status of each pending or recently decided award.
Our vision is simple, we work hard to combat the unfair and unjust claim denials so our doctors can enrich their practice and minimize and reverse losses.