Out-of-network revenue recovery
IDR Services for
Independent Practices
Independent dispute resolution (IDR) services for healthcare providers: assess underpaid out-of-network claims, manage open negotiation, prepare eligible No Surprises Act disputes, and follow up on payment alongside your billing team.
IDR support on your practice’s side.
Our service supports practices seeking help with eligible out-of-network payment disputes. Clearest works on the provider’s side; the certified IDR entity independently decides a federal dispute.
Federal IDR applies to certain out-of-network services under the No Surprises Act. State rules can determine the payment route instead. An underpayment alone does not establish eligibility. Read CMS’s explanation of the process.
Some claims need another route
Medicare and Medicaid claims are outside federal IDR. A coverage denial may need a coverage appeal rather than a payment-rate dispute. Confirm the plan, service, and reason for denial before proceeding. See CMS’s eligibility guidance.
Give the review a clear starting point.
Bring your billing lead into the initial discussion. We can establish what records are available and agree on a secure handoff before reviewing individual claims.
- Claim numbers, service dates, procedure codes, and places of service.
- Complete explanations of benefits or remittance records, including payment or denial information.
- Health plan details and payer contact information.
- Prior negotiation notices, correspondence, and dates of receipt or submission.
- Relevant supporting records and the person authorized to act for the practice.
Missing records can affect the assessment. CMS lists the information needed to initiate a dispute. For a fuller explanation, read our IDR eligibility and document guide.
From assessment to payment follow-up.
Review the opportunity
Clearest reviews the claim and payment records to assess eligibility, available evidence, and whether pursuing a dispute makes sense. Missing information is a reason to investigate, not a reason to assume eligibility.
Manage open negotiation
We prepare the negotiation materials and manage the payer follow-up for claims accepted into the service. Your practice and biller keep us informed of new correspondence and payments.
Prepare and submit the dispute
If negotiation does not resolve an eligible dispute, we assemble the supporting documentation, prepare the payment offer, and manage the filing. The evidence must fit the claim and the applicable rules.
Follow the payment
We track the outcome and follow up on payment. Your biller confirms receipts and posts them to the correct claims. A determination and a payment received are separate milestones.
Federal IDR follows an open negotiation period. Filing windows, exceptions, and process changes matter; check current CMS instructions for the applicable dispute. Filing does not guarantee an award or collection.
Keep your practice and biller involved.
IDR support depends on an ongoing exchange of accurate records. Agree on who supplies information, who approves decisions, and who confirms payment before the first case.
Clearest
Assesses cases, prepares dispute materials, manages the agreed IDR workflow, and follows up on case outcomes and payments.
Your practice
Provides accurate records and authorization, identifies a decision-maker, and responds when additional facts or approvals are needed.
Your billing team
Continues routine billing, shares payer notices and remittances, and reconciles receipts. Agree on an export or handoff that fits your systems during onboarding.
Make the commercial terms explicit.
Clearest offers recovery-based pricing. Before engagement, review the written agreement and ask:
- What percentage applies, and to which recovered amounts?
- Who advances administrative and IDR entity fees, and when are expenses reimbursed?
- What happens if a case is ineligible, withdrawn, unsuccessful, or unpaid?
- What reporting will the practice receive, and how will payments be reconciled?
- How does termination work, including disputes already in progress?
The agreed terms govern your engagement. Review the services agreement and discuss the scope for your practice.
THE RESOURCE COLLECTION
For your practice.
For the next decision.
Practical guidance for the work.
A closer look at your options.
How evidence informs an IDR offer
Distinguish the QPA, party offers, determinations, and supporting evidence.
Eligibility, documents, and fees
Check the applicable route and prepare the right records.
Federal IDR batching rules for 2026
Check negotiation dates, batch records, and the applicable cooling-off rules.
IDR support for surgical specialties
Connect surgical professional claims, service records, payer responses, and billing responsibilities.
IDR support for emergency medicine practices
Review emergency physician claim records, payment-dispute routes, and billing responsibilities.
IDR support for anesthesia practices
Prepare anesthesia claim records and define the review and billing handoff.
When an IDR award remains unpaid
Use a blank reconciliation worksheet and payer trace request example.
HaloMD vs. Clearest: IDR Services & Fee Questions
Compare HaloMD’s public IDR service information with Clearest’s support: case preparation, billing handoffs, fee questions, and outcome reporting.
Alteva RCM vs. Clearest: Billing and IDR Scope
Compare Alteva RCM’s billing and revenue cycle services with Clearest’s specialist IDR support. Review responsibilities, fee questions, and practice fit.
06 / YOUR NEXT STEP
Discuss Your
Practice’s Claims
Tell us about your specialty, billing workflow, and the payment issues you want to address. Start with a consultation; arrange claim-document transfer separately.
Discuss your practice’s claimsContent and sources reviewed . General information; eligibility depends on the claim and applicable rules.
