Facility claims, argued with facility evidence. Not a template.
Hospitals and surgery centers carry fewer, larger disputes. The work is knowing which facility claims the No Surprises Act covers, then arguing each one with your facility’s evidence.
Built for ascs and hospitalsEligibility screened before filing
The codes the engine reads first.
Emergency facility claims are the core of facility IDR. Scheduled care at an out-of-network facility is a different case; see the first question below.
- Revenue code 045XEmergency room facility charges
- Revenue codes 036X, 049XOperating room and ambulatory surgery services
- 10004 to 69990Surgical procedure codes on the facility claim
- UB-04 / 837IThe institutional claim the engine reads
How your claims reach a decision.
Step 1: Emergency facility care
Emergency services at an out-of-network hospital emergency department or freestanding emergency department are covered.
Step 2: Scheduled care, checked first
Scheduled care at an out-of-network ASC is generally outside the federal process. Filing it anyway is a common way vendors run up ineligible fees.
Step 3: State law, where it reaches
Some state laws reach further for fully insured plans. The engine checks both before anything is filed.
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 $520 stays due either way.
| Line | Amount |
|---|---|
| Billed charge | $12,000 |
| Initial payment (taken as the QPA) | $2,600 |
| Award at 2x the QPA | $5,200 |
| Added cash, if the payer pays in full | $2,600 |
| Award-based vendor, 20% of the uplift, due paid or not | $520 |
| Revise, 19% of cash collected | $494 |
| You keep with Revise, on this one claim | +$26 |
Illustrative. Assumes the award is paid in full. Fronted admin and IDRE fees not shown.
What breaks today. What changes with Revise.
Today
- Facility claims that need facility evidence, not a template.
- IDRE fees that are larger for big disputes and hurt more when fronted from operating cash.
- Boards that want the status of every open dispute, now.
With Revise
- Briefs with exhibits: acuity, case mix, teaching status, market data and prior contracted rates.
- Every CMS and IDRE fee fronted by Revise and recouped from the award.
- A portal your CFO can open in a board meeting.
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.
Our ASC is out of network for a plan. Can we dispute scheduled cases?
Usually not under the federal process, which covers emergency care and care by out-of-network providers at in-network facilities. Some state laws go further. The engine checks each claim and tells you before anything is filed, and an ineligible filing is our cost, not yours.
Can you work the hospital and the physician claims from the same visit?
Yes, when both are clients. Each is its own dispute; the portal links them so you can see the whole encounter.
How large is the fronted-fee commitment for a hospital?
We size it in the audit from your volume. The fees are ours to carry; you never fund an operating account.
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
- 4CMS fact sheet, Federal Independent Dispute Resolution Operations final rule (2026): open negotiation through the federal IDR portal, response by business day 15, eligibility decided within 5 business days of IDRE selection, three batching options. 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