Frequently Asked Questions

Teramed handles No Surprises Act open negotiation and federal independent dispute resolution (IDR) end to end for out-of-network specialty practices. We also support state IDR processes, payment integrity audits, compliance consulting and staff training.

Your front desk forwards the remittance or EOB for underpaid or denied out-of-network claims. We handle eligibility screening, deadlines, negotiation, filing and payment follow-up.

We charge a competitive percentage of what we successfully recover and nothing upfront. We cover the CMS and IDRE fees, and if a dispute is lost, you pay nothing.

You owe nothing. We absorb all costs of a lost dispute, including the CMS administrative fee and the IDR entity fee.

Yes. Some claims are governed by a state surprise-billing law instead of the federal process. We determine which process applies to each claim and handle both.

Send us a sample of recent out-of-network remits and we'll tell you which claims are IDR-eligible.

Federal independent dispute resolution (IDR) is the process created by the No Surprises Act for settling out-of-network payment disputes between providers and health plans. A certified IDR entity reviews one offer from each side and selects one of them. The decision is binding.

Generally: out-of-network emergency services, non-emergency services by out-of-network providers at in-network facilities (without valid patient consent), and out-of-network air ambulance services, for patients in private group or individual health coverage, where no state surprise-billing law applies instead. Open negotiation must be completed first, and filing deadlines met.

Yes. The open negotiation notice must be sent within 30 business days of the plan's initial payment or denial, and the 30-business-day negotiation period must end without agreement before either side can initiate federal IDR.

The IDR entity must issue a determination within 30 business days of being selected, and any payment owed is due within 30 calendar days after that. Counting open negotiation, a claim that goes all the way to a determination typically takes around four to six months from the initial payment. Many claims settle sooner in open negotiation.

The QPA is generally the plan's median contracted rate for the same or similar service in the same geographic area, adjusted for inflation. The IDR entity must consider it, along with other factors such as the provider's training and experience, patient acuity, case complexity and past contracting efforts.

Yes, within limits. Claims can be batched when they involve the same provider or facility, the same plan, the same or similar items or services, and fall within the permitted time window. Batching can significantly reduce fees, but a poorly built batch can cause problems for the whole submission.

No. Federal IDR is a payment dispute between the provider and the health plan. Under the No Surprises Act, the patient's cost-sharing for protected services is limited to in-network levels, and the patient isn't a party to the dispute.

Often, yes. Self-funded employer plans are generally governed by federal law and use the federal IDR process. Fully insured plans may be subject to a state surprise-billing law and a state dispute process instead.