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Emergency physicians treat every patient who comes through the door—no network check, no chance to negotiate first. When health plans underpay those out-of-network visits, LibeCore uses federal Independent Dispute Resolution (IDR) to recover what your group is owed.
Request a Free Legacy AuditFederal law requires emergency departments to screen and stabilize every patient, regardless of insurance. That means your group sees patients from plans it has no contract with, every shift. The No Surprises Act protects those patients from balance bills—they owe only their in-network cost sharing—but it leaves the payment question between your group and the health plan.
Plans often anchor their payment to the qualifying payment amount (QPA), their own median in-network rate. That number may not reflect what it costs to staff a department around the clock. IDR is how you challenge it.
Emergency medicine underpayments tend to be numerous and modest per visit. Disputing them one at a time rarely makes sense. Federal rules let you batch qualifying claims—the same or similar service, billed to the same plan, and furnished within the same 30-business-day period—into a single dispute. Batching turns a stack of small shortfalls into disputes worth pursuing. It also multiplies the deadlines and paperwork, which is where a dedicated IDR team earns its keep.
After receiving your claim, the plan has 30 calendar days to send an initial payment or a notice of denial, along with its QPA. That starts the 30-business-day open negotiation period, followed by a 4-business-day window to initiate IDR. With hundreds of visits a month, each on its own clock, deadlines are where emergency groups most often lose recoverable revenue.
A 30-business-day negotiation window opens after the plan's initial payment or denial.
If unresolved, we file within 4 business days through the CMS Federal IDR portal.
We assemble the evidence and payment offer the arbitrator will weigh.
A certified arbitrator selects one offer, and the plan must pay within 30 calendar days.
In IDR, the certified arbitrator considers the QPA along with additional information either side submits—including the acuity of the patient and complexity of the service, the training and experience of the treating physician, and each party's good-faith efforts to reach a network agreement. For emergency care, clear documentation of acuity and complexity, such as visit level and critical care time, is often what separates a strong offer from a weak one.
We review your out-of-network remittances to find claims that are eligible and worth disputing, open negotiation with each plan, group qualifying claims into batches, and file through the CMS portal inside the deadline. We build each offer around your clinical documentation and manage the arbitration to a decision. Many states also run their own surprise-billing arbitration for plans they regulate, and LibeCore handles those state processes too, so every claim goes to the right forum.
Are all emergency visits eligible for IDR?
Emergency services are covered by the No Surprises Act regardless of network status, but eligibility depends on the type of plan and whether a state surprise-billing process applies instead. Every claim must also go through the 30-business-day open negotiation period first.
Can we bill the patient for the difference?
No. For covered emergency services, the patient owes only their in-network cost sharing. The dispute is strictly between your group and the health plan.
Is it worth disputing lower-dollar visits?
Often, yes—when similar claims to the same plan are batched together. We'll show you where the recoverable dollars are before you commit to anything.
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See exactly what you're owed. We'll review your underpaid out-of-network claims and show you the recovery opportunity—no cost, no obligation.