Base units, time units and a QPA nobody can check. We check it.
Anesthesia is care the patient never chose, so out-of-network claims at in-network facilities fall under the No Surprises Act. The payer’s QPA rarely shows its work. The engine audits it before an offer goes out.
Built for anesthesiaThe QPA audited unit by unit
The codes the engine reads first.
Under the 2026 operations rule, anesthesiology items within the same Category I CPT code section can be batched together.
- 00100 to 01999Anesthesia services, billed as base units plus time units
- 99100 to 99140Qualifying circumstances, such as extreme age or emergency conditions
- AA, QK, QX, QY, QZModifiers for personally performed, medically directed and CRNA services
- 64400 to 64530Nerve blocks for post-operative pain
How your claims reach a decision.
Step 1: Care the patient never chose
Out-of-network anesthesia at an in-network hospital or ASC is covered, and the patient cannot be asked to waive it.
Step 2: Units checked against the QPA
Units and modifiers have to reconcile with the payer’s QPA. Mismatches are the most common reason the payer’s number is wrong.
Step 3: Federal or state, per claim
Self-funded plans go federal. Fully insured plans in states with their own law go to the state process.
One claim, priced both ways.
Paid in full, the two fees are close. If the payer never pays, Revise costs you nothing.
Our fee if the payer never pays this award. An award-based fee of $156 stays due either way.
| Line | Amount |
|---|---|
| Billed charge | $3,200 |
| Initial payment (taken as the QPA) | $780 |
| Award at 2x the QPA | $1,560 |
| Added cash, if the payer pays in full | $780 |
| Award-based vendor, 20% of the uplift, due paid or not | $156 |
| Revise, 19% of cash collected | $148 |
| You keep with Revise, on this one claim | +$8 |
Illustrative. Assumes the award is paid in full. Fronted admin and IDRE fees not shown.
What breaks today. What changes with Revise.
Today
- QPAs that ignore time units or the medical direction modifier.
- Open negotiation notices sent late, or without the disclosures the rule requires.
- A vendor contract that locks the group in for three years regardless of results.
With Revise
- QPA plausibility checks against public benchmarks and our award history, unit by unit.
- Batches by CPT section, as the 2026 rule allows.
- Month-to-month after 90 days. We keep you by winning.
One fee. Only on cash collected.
Our fee: 19% of cash collected. Nothing if we collect nothing.
Free claims audit to start- 01
We front every fee
CMS and IDRE fees are paid by Revise and recouped from the award. You fund no operating account.
- 02
Paid when you’re paid
Billed monthly on reconciled remits. If the payer doesn’t pay, neither do you.
- 03
No lock-in
90 days, then month-to-month with 30 days’ notice. No exclusivity.
Do you handle CRNA claims billed under the group?
Yes. The engine reads the modifier on each line, so medically directed and CRNA services are priced and argued on their own terms.
What if the payer’s QPA is per unit and ours is per case?
We normalize both to the same basis before we compare them, and the brief shows the arithmetic so the IDRE can follow it.
Can you work our ASC cases as well as hospital cases?
Yes, when the ASC is in network for the patient’s plan. If the ASC is out of network and the case was scheduled, the federal process usually does not apply, and the engine will say so before anything is filed.
Send us one month of remits.
We’ll show you what you left on the table.
Seven business days. No cost. A line-by-line report of eligible claims you didn’t file, QPAs that don’t add up, and awards you were never paid.
Sources
- 1McGough, Kurani and Long, "The performance of the federal independent dispute resolution process through mid-2024," Peterson-KFF Health System Tracker, May 29, 2025. Providers prevailed in 68% of disputes in Q1 2023 and 85% in Q1 2024; 80% across 2023 to mid-2024. Source
- 7Watts and Hoadley, "No Surprises Act arbitrators vary significantly in their decision making patterns," Georgetown CHIR, July 10, 2025: provider win rates ranged from 19% to 99% across IDR entities and years (2022 to mid-2024). Source