No Surprises Act dispute resolution
Out-of-network claims, worked from remittance to payment.
InfiniT Resolutions runs the federal dispute process for provider groups: screening, open negotiation, filing, offers and collection. We advance the federal fees. Our share is calculated only on what the plan pays above its initial payment, and we absorb both federal fees on a lost dispute. You pay nothing else.
- Screened before fees are spent Every claim is checked before it costs anything to file.
- Fees advanced by us Federal administrative and IDR entity fees are paid by InfiniT.
- Patients never billed The dispute is between your practice and the health plan.
Screening
Every claim is screened before a dollar of fees is spent.
A dispute filed in the wrong process wastes fees and invites a challenge from the plan. So each claim goes through an eligibility screen first: plan type, whether the No Surprises Act protects the service, whether a state law governs it, cooling-off periods and filing windows.
You see what was ruled out and why. Nothing is filed on a claim that has not cleared.
Illustrative examples, not client data.
- Anesthesia at an in-network hospital, self-funded employer planEligible: ready for open negotiation
- Emergency visit, fully insured plan in a state with its own surprise-billing lawRuled out: the state process applies
- Same service, same plan as a dispute decided last monthHeld: cooling-off period, filed when the window opens
- Medicaid claimRuled out: public programs are outside the federal process
The process
Eight steps, every clock tracked.
Federal rules set a deadline for each step, most of them counted in business days. Miss one and the claim is lost. We track every clock on a federal holiday calendar.
Who does what
We do the filing work. Your practice keeps the decisions.
InfiniT handles
- Remittance intake and claim matching
- Eligibility screening, with a reason for every claim ruled out
- Open negotiation notices and negotiation with the plan
- Federal IDR filing, as your authorized representative
- Federal fees, advanced by us
- Offers and briefs, each reviewed by a named person
- Payment tracking, reconciliation and refund clocks
Your practice
- Signs the BAA, services agreement and representative authorization
- Sends remittances through your clearinghouse
- Approves or declines any settlement offer
- Shares facts about the care when an offer needs them
- Receives payment and pays our share of what the plan paid above its initial payment
Results
How we will count results
We do not publish numbers we cannot back up. We will publish results once we have closed disputes to count, using these definitions.
- A win
- A determination in which the certified IDR entity selects our offer. Settlements reached in open negotiation are reported separately, not as wins.
- Recovered dollars
- Money the plan actually paid above its initial payment, less any refund owed back to the plan. An award that has not been paid is not counted.
- The ineligible rate
- Of the disputes we file, the share a certified IDR entity finds ineligible. We also report how many claims we ruled out at screening, before any fee was spent.
- The date range
- Every figure names its period and counts disputes by the date they closed. Disputes still open are not counted.
Patients stay out of the middle.
InfiniT never bills patients. The No Surprises Act exists to keep patients out of payment disputes between providers and health plans, and that is how we work.