The No Surprises Act runs two separate processes: open negotiation first, then IDR — baseball-style arbitration where the arbiter picks one side's exact number. The cheapest win comes before the arbiter: settle in open negotiation and you skip the fees and the coin-flip. Avertyn builds the QPA-anchored, defensible offer that wins at either stage, and files it for you.
Free exposure analysis no card, no sales call built on the June 2026 Federal IDR Operations Final Rule
The No Surprises Act keeps open negotiation and IDR separate and sequential. Most disputes should end in the first stage, where there's no fee and no arbitration.
A 30-business-day, party-to-party window, with a response due by the 15th business day. No arbiter, no fee. Avertyn drafts the QPA-anchored counteroffer that gets providers to settle — because escalating costs them too.
Now it costs: $15 per party plus the certified-IDRE fee, and it's baseball-style — one number wins, and providers have prevailed ~80% of the time. Avertyn still builds the winning offer, but this is the stage to avoid.
Every dispute resolved in open negotiation skips the IDR fees and the arbitration entirely — that's the cheapest, fastest win, at a defensible number.
Move the sliders to your out-of-network dispute volume. This models what you're likely overpaying today versus a QPA-anchored defense — using the public IDR outcome ranges, not a sales fantasy.
Illustrative model for orientation, not a quote or a guarantee. It applies public federal-IDR outcome ranges (Peterson-KFF, CMS) to the numbers you enter; your actual results depend on your book, your specialties, and the arbiter. A real Avertyn exposure report uses your own claims.
The process rewards the side that submits the better-documented, more defensible number, on time. Avertyn builds exactly that, on every case.
Every offer is anchored to the qualifying payment amount and a defensible ceiling — default 125% of QPA, capped at the regional median. Un-inflatable, and credible to the arbiter.
Two separate clocks on one calendar: the 30-business-day open-negotiation window (response due by day 15) and, only if it fails, the IDR timeline — entity selection, eligibility, offer, additional info. CMS counts federal holidays, so we do too.
Screen every dispute inside the 5-business-day review window and catch the ineligible ones before you overpay a claim that never belonged in IDR.
Turn the repricer's number into a documented counter the arbiter can adopt — with the evidence that makes your offer the reasonable one.
Batch up to the 50-line-item limit — including cross-specialty batching for radiology, anesthesia, pathology and lab under the June 2026 rule — without tripping eligibility.
Generate the complete IDR submission — offer, supporting evidence, and rationale — formatted and ready to file. Best-in-class, in a click.
Bring in your remittances and open disputes. Avertyn maps every case to its QPA, its eligibility, and its exact deadline.
Each case gets a defensible, QPA-anchored offer and a holiday-aware business-day deadline. The cases most at risk surface first.
Send the open-negotiation offer that ends most disputes before any fee. Only the ones that don't settle go to IDR, where the same defensible offer is filed to win.
IDR rewards preparation and punishes thin staffing. Avertyn gives lean teams the leverage of a specialized defense unit.
You administer the plan and eat the losses when a dispute goes sideways. Avertyn defends every case to a QPA-anchored number and never misses a deadline — without adding headcount.
Start free with an exposure view: what IDR is costing the plan in default losses and winnable cases. Bring the numbers to your TPA — or to renewal.
Want certainty, not just defense? The Performance Guarantee puts a contracted ceiling on your IDR-loss rate, priced as a premium over fair value.
| On every dispute | Doing nothing | A repricer alone | Avertyn |
|---|---|---|---|
| Offer anchored to the QPA | — pay near the demand | a number, not a defense | ✓ 125% of QPA, capped at median |
| Deadlines tracked (holiday-aware) | ✕ easy to forfeit | not their job | ✓ every window, to the day |
| Eligibility screened | ✕ | ✕ | ✓ caught in the 5-day window |
| Filing generated & evidenced | ✕ manual | partial | ✓ one click, arbiter-ready |
| Priced on | the default loss | % of "savings" | work + defended dollars |
A platform subscription plus ~20% of the dollars we defend above the QPA — anchored to the QPA, so it can't be inflated. You keep ~80%. Start free with an exposure view.
Founding-customer rate: 15% of defended dollars for the first 10 plans, through Dec 2026 — locked for your contract term.
Avertyn is built directly on the June 2026 Federal IDR Operations Final Rule. No inflated demands, no cut of fictional "savings" — you win when the number is right and defensible, not when it's big. That alignment is the product.
Sources: CMS — Federal IDR Operations Final Rule fact sheet.
We state what's live versus in progress on purpose. Security posture is documented and updated as controls mature.
Get a free exposure analysis of your out-of-network disputes — default losses, winnable cases, and dollars at risk. No card, no sales call. We'll follow up when your early-access spot opens.
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