Contingency-based IDR recovery — get a free audit.
Pathologists work behind the scenes on specimens from surgeries, biopsies, and hospital stays—care the patient chose, from a group they never met. When plans underpay that work, LibeCore uses federal Independent Dispute Resolution (IDR) to recover what you're owed.
Request a Free Legacy AuditWhen a patient has a procedure at an in-network hospital or surgery center, the specimen often goes to a pathology group the plan doesn't contract with. The No Surprises Act counts pathology and laboratory work among the ancillary and diagnostic services that patients can't be asked to waive protections for when they're furnished in connection with a visit to an in-network facility. The patient owes in-network cost sharing; the rest is between your group and the plan.
Most pathology claims are individually modest, which makes them easy for plans to pay at their qualifying payment amount (QPA), their median in-network rate, and hard for groups to challenge one by one. Federal rules allow qualifying claims for the same or similar service, to the same plan, furnished within the same 30-business-day period, to be batched into a single dispute. For pathology, batching is usually what makes IDR worthwhile.
Because they're spread across many small remittances, pathology underpayments are easy to miss. Common patterns include out-of-network payments that land exactly on the plan's in-network rate, partial payments on multi-specimen cases, and line items reduced to a lower-paying code. Each one carries its own negotiation and filing deadline, so finding them early matters.
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.
Arbitrators consider the QPA together with additional information, such as the complexity of the case—multiple specimens, special stains, or immunohistochemistry—and the training and subspecialty expertise of the pathologist. A well-built submission draws that detail straight from your reports rather than relying on billing codes alone.
We sort your out-of-network claims to find those eligible for IDR, separate professional and technical components where they're billed separately, batch by service code and plan, complete open negotiation, and file through the CMS portal on time. We then manage the arbitration and track payment. 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.
Does IDR cover lab work that isn't tied to a facility visit?
Usually not. The No Surprises Act's protections center on emergency care and services connected to visits at in-network facilities. We'll review your claim mix and show you which claims qualify.
Can we balance-bill the patient?
Not for covered services. Pathology furnished in connection with an in-network facility visit is protected, and notice-and-consent waivers don't apply to it.
Do we need to change how we bill?
No. We work from your existing claims and remittances. Your team keeps billing as usual while we handle the disputes.
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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.