Win More Out-of-Network Disputes with Federal IDR
Expert Independent Dispute Resolution under the No Surprises Act, engineered for the new 2026 rules.
The IDR Landscape Has Shifted in Your Favor
Providers are winning. As of H1 2025, providers prevail in 88% of federal IDR disputes, with median awards reaching roughly 450% of the median in-network rate. With the May 2026 rule changes slashing filing costs and expanding batching, the economics of disputing underpaid claims have never been stronger.
CounterClaim manages the entire IDR process end to end, so you capture the revenue you have earned without adding administrative burden to your team.
From Underpayment to Award
The federal IDR process is deadline-driven and unforgiving. We manage every step with precision.
Initial Payment or Denial
The health plan issues an initial payment or notice of denial. Our system flags underpaid claims and assesses IDR eligibility immediately.
Open Negotiation
A mandatory 30-business-day direct negotiation period begins. We engage payers with data-backed positions from day one.
IDR Initiation
If negotiation fails, the dispute must be filed within 4 business days. We never miss the window.
Entity Selection
Both parties select a certified IDR entity. We guide selection strategically based on historical outcomes.
Baseball-Style Arbitration
Each side submits a single binding offer. Our analysts build offers designed to win, supported by market data that strengthens your position beyond the QPA.
Decision and Award
The arbitrator rules within 30 business days, weighing the QPA alongside additional factors we present on your behalf.
Built for the May 2026 Rules
The federal IDR process changed significantly in May 2026. CounterClaim is already operating under the new framework.
Lower Costs, Higher Volume
Administrative fees dropped from $115 to $15 per party, making it economical to dispute claims that were previously too small to pursue.
Smarter Batching
Up to 50 related services can now be batched into a single claim. We batch strategically to minimize your per-claim costs.
Payer Disclosure Codes
Payers must now use specific codes signaling IDR eligibility. Our platform reads these signals automatically to identify disputable claims.
IDR Gateway Portal
All disputes are now managed through the centralized federal portal. We handle every filing, submission, and status update inside it.
5-Day Response Windows
Data requests now carry strict 5-business-day deadlines. Our workflows are built to respond well inside the window, every time.
Already Compliant
We rebuilt our entire workflow around the 2026 framework before it took effect — no catch-up, no learning curve.
Talk to usWe Don't Dispute Everything. We Dispute to Win.
A disciplined, data-led filing strategy that protects your win rate and your resources — not a spray-and-pray volume play.
Selective Filing
We use outcome data to target high-probability wins rather than flooding the system, protecting your win rate and your resources.
Smart Batching
We leverage the 50-service batching limit to consolidate related claims and drive down administrative cost per dollar recovered.
Deadline Management
Rigorous RCM workflows ensure every 4-day filing window and 5-day response window is met without exception.
We Watch the Rules So You Don't Have To
The Texas Medical Association's ongoing challenge to the QPA calculation methodology remains a wildcard. A pending en banc rehearing before the Fifth Circuit could vacate current rules and raise benchmarks in providers' favor. Whatever the outcome, our clients are positioned to adapt first.
Recover What You've Earned
Underpaid out-of-network claims are recoverable revenue. Let us show you how much is on the table.
Talk to an IDR Specialist
Get a no-obligation assessment of your out-of-network claim portfolio and see where recoverable revenue is sitting.
- End-to-end management of the federal IDR process
- Selective, outcome-driven filing strategy
- Full compliance with the May 2026 rules
- No added administrative burden on your team
Recover What You've Earned
Underpaid out-of-network claims are recoverable revenue. Let us show you how much is on the table.