Independent Dispute Resolution Services Under the No Surprises Act
URAC-accredited Independent Organization helping providers and payers resolve payment disputes with accuracy, compliance and efficiency.
Expert Guidance Through Every Step of the IDRE
Process
As an approved Independent Dispute Resolution Entity (IDRE) under the No Surprises Act, EdiPhy Advisors helps resolve payment disputes between healthcare providers and payers. Our team understands the stakes: delayed or incorrect payments can significantly impact financial stability. We provide a structured, compliant process to ensure fair, timely resolutions.
We work with both initiating and non-initiating parties, delivering impartial, evidence-based determinations that stand up to regulatory scrutiny.
A Trusted, Accredited IDRE Partner
We bring together clinical, operational, and regulatory expertise to
ensure every case is handled with precision and fairness.
URAC-Accredited Independent Review Organization since 2014
Decades of experience in medical, legal, and regulatory compliance
Board-certified physicians, coding specialists, and compliance professionals on staff
Proven track record in resolving complex disputes under federal regulations
Commitment to responsive communication and strict confidentiality
A Clear, Compliant Path
to Resolution
Our process is built to meet federal requirements while minimizing administrative burden for our clients.
1. Case Submission
Parties submit the dispute with required documentation via our secure portal.
2. Eligibility Review
We confirm the case meets the criteria under the No Surprises Act. Questions regarding the No Surprises Act, or for more information regarding any of its provisions, visit www.cms.gov/nosurprises or the FAQ below.
3. Evidence Review
Our experts evaluate submissions from both parties.
4. Determination
A decision is issued based on the strongest evidence, in compliance with statutory timelines.
5. Communication
Results are shared promptly with all parties through secure channels.
For Providers, Payers, and Legal Teams
Our IDRE services are designed for:
- Hospital and healthcare system CFOs and revenue cycle leaders
- Denials management and compliance executives
- Health plan administrators
- Legal counsel representing healthcare organizations or payers
Whether you’re initiating or responding to a dispute, our team
ensures you have the guidance and expertise needed to navigate the process efficiently
Handle Your IDRE Case with Confidence
Our dedicated IDRE team responds quickly, connects you with the right experts, and ensures your case is handled with the highest standards of accuracy, impartiality, and compliance.
Answers to Common Questions About the IDRE Process
We’ve gathered answers to the most frequent questions from providers, payers, and legal teams navigating the Independent Dispute Resolution process under the No Surprises Act.
What is the No Surprises Act?
The No Surprises Act protects patients from certain unexpected medical bills and establishes the Independent Dispute Resolution (IDR) process to settle payment disputes between providers and payers.
Who can file an IDRE case?
Either the provider (initiating party) or the health plan (non-initiating party) involved in a qualifying payment dispute may request IDRE.
How do I know if my case qualifies?
Eligibility depends on the type of service, the patient’s coverage, and the billing circumstances. Our team reviews each submission to confirm it meets the criteria under the No Surprises Act.
How long does the process take?
Federal guidelines set specific timelines. Generally, determinations are made within 30 business days after all required documentation is received.
What documentation do I need?
Supporting materials may include payment records, explanations of benefits and relevant contracts or communications.
How are decisions made?
Our reviewers evaluate all evidence submitted by both parties and select the offer that best represents the value of the service, as defined by federal criteria.
Is the decision binding?
Yes. The IDRE determination is binding on both parties, except in cases of fraud or misrepresentation.
How do I start the process?
Submit your case through our secure online portal. We’ll confirm eligibility and guide you through next steps.
IDRE Form
Contact us to begin working through our IDRE process.
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