Contingency-based IDR recovery — get a free audit.
Patients rarely choose their radiologist—and often never meet them. When a health plan underpays your out-of-network reads, LibeCore uses federal Independent Dispute Resolution (IDR) to recover what your practice is owed.
Request a Free Legacy AuditRadiologists routinely read studies ordered at hospitals, emergency departments, and surgery centers where the patient's plan has a contract with the facility but not with your group. The No Surprises Act treats radiology as an ancillary service: when it's furnished at an in-network facility, the patient can't be asked to waive their surprise-billing protections. They pay only in-network cost sharing, and the payment question moves to your group and the plan.
Radiology claims tend to be high in number and modest in value—a CT interpretation here, an MRI there, often billed as the professional component. Plans often base their payment on the qualifying payment amount (QPA), their own median in-network rate. A small shortfall per study becomes a large one across a year of reads.
Federal rules allow qualifying claims—the same or similar service code, billed to the same plan, and furnished within the same 30-business-day period—to be batched into one dispute. That makes routine imaging underpayments practical to pursue.
Many radiology groups bill only the professional component while the facility bills the technical component. A dispute has to match exactly what your group billed, including modifiers, and the plan's QPA should be calculated for that same code and modifier. Comparing a professional-only read against a global rate is a common way offers go wrong—and one of the first things we check.
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.
The arbitrator considers the QPA alongside additional information, including the complexity of the study, the training and subspecialty expertise of the reading radiologist, market share, and each side's good-faith efforts to contract. Subspecialty interpretations and complex studies are where careful documentation matters most.
We identify underpaid reads that are eligible for IDR, group them by service code and plan, complete open negotiation, and file through the CMS portal before the deadline. We build each offer from your reports and credentials and manage the arbitration through to 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.
Can the patient sign a waiver so we can bill them directly?
Not for radiology furnished at an in-network facility. Radiology is an ancillary service under the No Surprises Act, so notice-and-consent waivers don't apply. The dispute stays between your group and the plan.
What if the plan denied the claim instead of underpaying it?
Open negotiation can begin after either an initial payment or a notice of denial. Some denials raise coverage questions that IDR doesn't decide; we'll tell you which path applies to each claim.
Is it worth disputing individual reads?
Usually through batching. Grouping similar reads to the same plan is what makes routine imaging claims worth the effort.
New to IDR? Read our plain-language guide →
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.