Settle early. Never below your floor.
When a payer offer beats what IDR would likely pay, we settle it in open negotiation. You approve the floor. The payer pays you, not us.
Part of Revise IDR
- A floor on every line, approved by you
- Federal or Texas process, routed correctly
- A secure inbox where the payer accepts your offer
- A 30-day payment clock on every settlement
The problem
Most claims stop at the first payment
In payer-reported data for 2024, 76% of NSA claims ended at the initial payment and 6% reached IDR.21
After filing, few settle
Withdrawals, settlements and administrative closures were about 2% of federal IDR closures from January to July 2026.22
Texas shows it can work
From 2020 to 2023, 64% of Texas arbitration requests and 75% of mediation requests settled in the state’s free 30-day informal period.23
What you get
- A settle-or-file call on every line, with the reasoning on one screen.
- Notices with your opening offer, sent on your letterhead with proof of delivery.
- A secure inbox where the payer sees your offer for the listed lines and accepts or counters.
- Settlement papers from counsel-approved templates. Your approver signs.
- A payment clock. Federal law requires payment within 30 days of an amount agreed in open negotiation. Late payers get the same escalation as unpaid awards.24
- If no offer meets your floor, the dispute is filed inside the 4-business-day window.
How it works
- 01
Set your floors.
Approve a floor policy once. Change it any time.
- 02
We send the notice.
With your opening offer, as your representative.
- 03
The payer answers.
By fax, email or the inbox. Offers below your floor go to your approver.
- 04
Paid or filed.
Settled lines get a 30-day clock. The rest go to IDR on time.
Who it is for
- Texas freestanding ERs and emergency medicine groups
- Anesthesia and radiology groups
- Billing companies, under their own brand
What we never do
- Show payers market data or another client’s numbers
- Take a payment for you (payers pay your account)
- Settle below your floor without your approver
Pricing
Part of Revise IDR: 19% of cash collected above what you were paid before open negotiation. The same rate whether we settle or file.
When do you settle instead of filing?
When the payer’s offer beats what IDR would likely pay. Settling brings cash sooner, with no IDR fees and a signed promise to pay. When IDR is likely to pay more, we file.
Who approves a settlement?
You do. You set a floor policy once and can change it any time. Your approver signs every settlement, and nothing settles below your floor without that approver.
Does Settle cost extra?
No. Settle is part of Revise IDR: 19% of cash collected above your pre-negotiation payment, whether we settle or file. Every settlement is reported against what IDR would likely have paid.
What does the payer see?
Your offer for the listed lines, by fax, email or a secure inbox where they can accept or counter. We never show payers market data or another client’s numbers.
What if the payer agrees and does not pay?
Federal law gives the payer 30 days to pay an amount agreed in open negotiation. We track that clock and escalate late payers the same way as unpaid awards: demand letters and complaints to regulators. Litigation goes to counsel you choose.
Does this work in Texas?
Yes. State-regulated plans go to the Texas process, which has its own 30-day informal settlement period. Self-funded plans go federal. We never file the same claim in both.
Sources
- 21AHIP and Blue Cross Blue Shield Association, No Surprises Act survey brief, October 2025 (payer-reported): 76% of 2024 NSA claims ended at the initial payment, 24% entered open negotiation, 6% reached IDR. Source
- 22CMS, Federal IDR reports and bi-monthly data through July 31, 2026: withdrawals, outside settlements and administrative closures were 2.0% of closures from January to July 2026. Source
- 23Texas Department of Insurance, Balance Billing Biennial Report, November 2024: 64.29% of arbitration and 74.91% of mediation requests settled in the first 30 days (2020 to 2023); ER doctors billed as out-of-network fell from 58% (2019) to 48% (2023). Source
- 2442 U.S.C. 300gg-111(c): open negotiation, payment of an amount agreed in open negotiation within 30 days, and what an IDR entity may and may not consider. Source
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