OON-IDR

Out-of-Network IDR - Win the Dispute Before it Starts

In the No Surprises Act’s Independent Dispute Resolution (IDR) process, the arbitrator’s decision hinges on one thing: who brings the most credible, concrete evidence of market-consistent reimbursement rates. FlexPoint puts that power squarely in your hands.

EOBs: Irrefutable Evidence in IDR Arbitration

When payers challenge your rates in IDR, they rely on incomplete datasets, stale MRFs, and self-reported benchmarks. FlexPoint counters with actual EOB documents — real claims, stripped of PHI, sourced directly from patients. These are not estimates. They are the are the actual negotiated rates paid by insurers to providers, specific to insurer product, specific to Tax ID / NPI, and dated within the last 30 days.

Arbitrators are required to weigh Qualifying Payment Amounts (QPA) against credible market data. There is no more credible market data than an EOB.

Why This Matters in the IDR Process

Certified and submittable. FlexPoint delivers actual EOB documents you can submit directly as exhibits in your IDR filing — not summaries, not reports derived from data. The source document itself.

Granular by insurer and reimbursement methodology. EOBs capture how payers actually pay — not what they claim to pay.

Shifts leverage to providers. When your evidence is more current, more specific, and more verifiable than the payer’s, the arbitrator takes notice. FlexPoint clients enter IDR with a structural advantage.

When MRFs fail you, EOBs don't.

Machine-Readable Files are often incomplete, outdated, or missing entirely. In IDR — where every dollar counts — FlexPoint fills those gaps with EOB-derived datasets that are just as actionable and far more defensible. Whether you’re validating existing benchmarks or building your rate evidence from scratch, FlexPoint ensures you never walk into arbitration empty-handed.