A payer underpaid you—but you don't have to accept it. Under the No Surprises Act, providers can dispute an underpaid out-of-network claim and pursue fair reimbursement. Here's how the process works, step by step.
Start by comparing the plan's payment to what the claim is truly worth—your usual rates for the service, the qualifying payment amount (QPA) the plan used, and what's reasonable for your specialty and area. If the payment is clearly below fair value, you likely have grounds to dispute it.
This is where most providers lose money: the No Surprises Act dispute process runs on tight, unforgiving deadlines. Miss a window and you forfeit the right to dispute that claim entirely. Here's the timeline.
You have a 30-business-day window after the payer's payment or denial to negotiate the underpayment directly.
If negotiation fails, you have just 4 business days after that window to formally start Independent Dispute Resolution (IDR).
Each side submits one payment offer with supporting evidence to a certified, neutral arbitrator.
The arbitrator picks one of the two offers. It's binding—and the losing side pays the arbitrator's fee.
Because IDR is "baseball-style"—the arbitrator picks one offer, not a middle ground—your submission has to be well-documented and defensible. Strong offers back up the requested amount with the right evidence: your rates, the complexity of care, and how the plan's payment compares to fair value. A weak or rushed submission often loses.
Disputing underpaid claims yourself is possible—but it's deadline-driven, detailed work. LibeCore does it for you end to end: we confirm the underpayment, track every deadline, negotiate, and file and manage IDR with evidence-backed offers, so you collect what you're owed without tying up your team.
What's the deadline?
A 30-business-day open negotiation period, then only 4 business days to start IDR. Miss it and the claim is lost.
Do I involve the patient?
No—the No Surprises Act keeps patients out of it. The dispute is between you and the plan.
This guide is general educational information about the No Surprises Act dispute process, not legal advice.
New to IDR? Start with our plain-language guide: What is IDR? →
Request a free Legacy Audit. We'll review your underpaid out-of-network claims and show you what's recoverable—no cost, no obligation.