Underpaid claims.
Recovered revenue.
We quietly execute and fight for appropriate compensation on your behalf. We prioritize winning arguments through predictive insights.
The No Surprises Act gives providers the right to dispute underpaid out-of-network claims through federal arbitration. Most providers don't have the resources to use it. We built the platform that makes it work.
No cost to analyze · No obligation · Results in 5 business days
The Problem
Payers set the rate. Most providers accept it. You don't have to.
When you treat an out-of-network patient, the health plan decides what your work is worth — and that number is almost always wrong. On a $40,000 surgical case, you might see $9,000.
The federal government gave you the right to dispute it in 2022. The problem is the window to file closes fast, the process is claim-by-claim, and most groups don't have the staff or data infrastructure to have a consistent process.
Why We Exist
We exist to help providers recover revenue they're owed.
Payors will fight to not pay. That's their job. Ours is making sure you don't leave money on the table because the process is too complex or your team is too busy. We've spent years on the payor side of healthcare finance. We know how these decisions get made, and we use that to build stronger cases for providers.
Service Areas
IDR recovery across every major specialty
Out-of-network underpayment isn't limited to emergency medicine. Every specialty with OON exposure has claims the federal IDR process was designed to resolve.
Emergency Medicine
The biggest category by far. If your ER treats OON patients — travelers, tourists, anyone whose plan doesn’t include your facility — you’re leaving money on the table. These claims are explicitly protected under the NSA, and the payment gaps are significant.
Anesthesiology
Patients pick their surgeon, not their anesthesiologist. That means anesthesia is OON more often than almost any other service — even when the facility is in-network.
$3K–$25K per claim
Radiology
Imaging gets ordered in-network but read by OON radiologists. It happens constantly. CT, MRI, ultrasound, interventional — steady volume, consistent underpayment.
Surgery
Orthopedic, cardiac, neuro, spine. Complex cases with large billed charges where surgical assistants and specialty surgeons are frequently out-of-network. The payment gaps on these are often the biggest we see.
$10K–$80K per claim
Pathology
Most people don’t think of path as an IDR opportunity. But lab and pathology services are routinely provided by OON groups inside in-network facilities. It adds up.
Air Ambulance
Explicitly protected under the NSA. Rotary and fixed-wing transports with extremely high billed charges.
$30K–$150K per claim
Neurology & IONM
Intraoperative neuromonitoring during spine and brain surgery is almost always out-of-network. Niche, but the per-case value is high and the technical documentation actually strengthens the filing.
Hospital Systems
Even in-network hospitals generate OON claims — self-funded ERISA plans, carve-out arrangements, facility fees for ancillary services. If you run multiple sites, this compounds fast.
$15B+
Negotiated in healthcare deals
2M+
IDR case outcomes analyzed
30 days
Average time from filing to determination
How It Works
From claims data to recovered revenue
Connect your claims
We integrate with your EHR, practice management system, or billing platform to pull claims data. CSV exports, 837 EDI, HL7 FHIR, and direct API connections are all supported. Setup typically takes 48 hours.
We screen every claim
Our system analyzes each claim against No Surprises Act criteria — verifying network status, calculating payment gaps, checking filing deadlines, and scoring each claim’s IDR recovery potential. No manual review needed from your team.
We handle the entire dispute
Open negotiation with the plan, IDR filing through the CMS portal, offer calculation using market rate intelligence, case narrative generation, and deadline management. Your team focuses on patients.
Revenue flows back to you
When we win, additional payments go directly to your practice or facility. Our fee is contingency-based: we only get paid when you get paid.
Why Us
Health economists who've worked both sides of the table.
We know how payors think because we've worked for payors. That perspective — combined with $15B+ in negotiated healthcare deals — changes everything about how we build cases, price offers, and protect your broader payer relationships.
01Data-driven. 2M+ cases analyzed.
We’ve analyzed every published federal IDR outcome. We know how different arguments perform by payor, by arbitrator, by region. Your offer isn’t a guess — it’s a calculated position built on how decisions are actually made.
02Strategic, not transactional.
We navigate this process quietly, minimizing risk to your payer relationships. We know how payors think because we’ve worked for payors. A won arbitration that costs you a network contract isn’t a win — we manage the full picture.
03Zero operational burden.
We set up the data flows and start executing on your behalf. Claim screening, offer calculation, clinical narratives, CMS deadlines — all handled automatically. Your staff focuses on care delivery.
04We don’t get paid unless you do.
Fully contingency-based. No setup fees, no monthly minimums, no risk. We earn a percentage of recovered revenue only when we win additional payments for you.
The Platform
Everything between the underpaid claim and the recovered revenue
Six capabilities working together so your revenue cycle team doesn't have to.
Eligibility screening
Every claim checked against the full No Surprises Act criteria — network status, timely filing, service type, plan type — in seconds, not hours.
Market-rate offer engine
Offers calibrated to actual IDR outcomes in your region, for your payer, at your CPT codes. Priced to win, not to negotiate.
Case narrative generation
AI-drafted narratives that present clinical context, qualifying payment analysis, and statutory arguments — reviewed and filed without burdening your team.
Deadline management
Every IDR timeline tracked to the business day. Open negotiation windows, filing deadlines, response periods — nothing falls through the cracks.
CMS portal integration
Direct filing through the federal IDR portal. No manual uploads, no spreadsheet tracking, no missed submissions.
Outcome analytics
Real-time visibility into your case portfolio — recovery amounts, payer performance, and revenue forecasting.
Common questions
See what your claims are worth
Tell us your specialty and practice name, and we'll send you a custom report showing IDR outcomes in your market.
No sales call required. No cost. No obligation.
Or email us: info@mkbinsights.com
