No Surprises Act disputes
We dispute.You collect.
Spectare Health disputes underpaid out-of-network claims for independent physician groups, from the remittance to the award. The award is paid to you. Nothing upfront, and we’re paid only when the payer pays you more.
- $0
- upfront, and nothing owed if a dispute loses
- 30
- business days to open negotiation once the payer pays
- 1
- authorization to sign. We do the filing.
One claim, from remittance to award
01ReviewRemittance · 835
- 00790Anesthesia$612Eligible
- 74177CT abdomen$96Eligible
- 99214Office visit$88Not eligible
- 22633Spine fusion$8,750Eligible
- 99285ER, Medicare$310Not eligible
3 eligible · 18 business days left to open
02DisputeFederal IDR · 22633
- Negotiation opened
- Negotiation ended
- Dispute filed
- Offer and evidence sent
- Arbiter picks our offer
4-business-day filing window kept
03RecoverAward · 22633
Reconciled in your monthly statement
01The problem
Out of network, the payer sets its own rate. Challenging it means a federal process, deadlines counted in business days, and staff time most practices don’t have.
Paid by the payer’s own math
Most payers start from their qualifying payment amount: their median in-network rate, as they calculate it.
A clock that doesn’t wait
30 business days to open negotiation. Then 4 business days to file once negotiation ends. Miss one and the claim is closed.
A process built for specialists
Eligibility rules, state carve-outs, batching, arbiter selection, offers and evidence. One dispute is manageable; a month of them is a second job.
- Check whether a claim is eligible
Deadline checker
How long do you have?
Enter the date the payer paid or denied a claim.
Last day to open negotiation
30 business days later
Pick a date to see how much of the window is left.
02How it works
You send the remittances. We handle the rest.
01Review
We find the claims worth disputing
We screen every out-of-network line in your remittances against the federal rules and any state process, and send you a list of what qualifies, why, and the deadline on each.
02Dispute
We negotiate, then file
We open negotiation inside the 30-business-day window. If the payer won’t settle, we batch the claims, file in the CMS portal, and write the offer around what an arbiter may weigh.
03Recover
The award is paid to you
Awards go straight to your practice. We follow each one until it is paid, reconcile it against your remittance, and send one monthly statement.
What your team does
- Sends 90 days of remittances: 835 files, EOBs or read-only access
- Signs one authorization so we can file for your group
That’s the whole job on your side.
What Spectare does
- Screens every claim against federal and state rules
- Opens negotiation inside 30 business days
- Files within 4 business days and pays the filing fee
- Writes the offer and assembles the evidence
- Tracks every award until it is paid
- Reconciles it all in one monthly statement
03The public record
When practices dispute, arbiters mostly side with them.
- 85%
- of decided disputes went to the provider
- $15
- federal filing fee per dispute, down from $115
Median award as a share of the payer’s rate
All federal disputes, Q4 2025. The payer’s rate is its qualifying payment amount (QPA). Every quarter, state, code and payer is on the IDR outcomes pages.
04Why Spectare
Built so the risk sits with us.
Our fee comes out of money you didn’t have before. Everything else about how we work follows from that.
$0
upfront. If a dispute loses, you owe nothing.
No upfront fees
No setup fee and nothing to start. If a dispute loses, you owe nothing.
Paid from what we add
Our fee is a share of what we recover above the payer’s first payment. Never on what you already collected.
No minimum volume
A handful of large surgical claims or hundreds of radiology lines a month.
Almost no staff time
Your team sends remittances and signs one authorization. Nobody learns a new system.
Dispute specialists
No Surprises Act disputes are the whole job: eligibility, state carve-outs, batching, offers and evidence.
End to end
From the remittance to the award in your account, including payers who pay late.
05Who we help
Built for facility-based physician groups.
Groups paid out of network at hospitals and surgery centers that are in network, and emergency groups anywhere. If that is your group, the review will show what is there.
- 01
Anesthesia and CRNA groups
Steady monthly volume that batches cleanly. Consent waivers never apply to anesthesia.
- 02
Radiology groups
Many reads, few dollars each. At a $15 fee, and 50 lines per dispute from November 2026, imaging is finally worth filing.
- 03
Surgeons at in-network facilities
Spine, orthopedic, and general surgeons working out of network. Few claims, large awards.
- 04
Assistant surgeons and surgical assists
Routinely paid a fraction of the payer’s own rate, and usually nobody has disputed a line for them.
- 05
Independent emergency groups
Emergency services are protected everywhere, including claims that route to a state process.
- 06
Hospitalists, intensivists, neonatology, pathology
Facility-based specialties where payers lean hardest on their own rate.
Which claims qualify
Check a single claimQualify
- Emergency services at any facility, including care after stabilization
- Out-of-network care at an in-network hospital, outpatient department, or surgery center
- Patients on employer, individual market, or federal employee plans
Don’t qualify
- Medicare, Medicaid, and TRICARE
- Office visits
- In-network claims paid under a contract
- Scheduled care where the patient signed a consent waiver
- Coverage or medical necessity denials (those go to appeal)
06Pricing
We only succeed when you recover more.
Our fee is a share of what we recover above the payer’s first payment.
Payer’s first payment
Yours already. No fee on it.
Recovered above the payer’s first payment
The only part our fee comes from.
- If a dispute loses, you owe nothing
- Our fee is due only once the payer’s money reaches you
- We pay the federal filing fee and absorb the arbiter’s fee
- No setup fee
- No minimum volume
- No charge on what you already collected
- Nothing from patients
07FAQ
Questions practices ask
Short answers to what groups ask before a review. To test a single claim, the calculator checks eligibility and the deadline in your browser.
Try the IDR calculatorSomething else? Email us and we’ll answer within a day.
01How does the IDR process work?
Once the payer pays or denies an out-of-network claim, you have 30 business days to open negotiation. If 30 business days of negotiation don’t settle it, you have 4 business days to file a federal dispute. You and the payer each send one final offer to a certified arbiter, who must pick one of the two. The payer then has 30 calendar days to pay the award.
02Which claims are eligible?
Out-of-network emergency care at any facility, including care after stabilization, and out-of-network care at an in-network hospital, outpatient department or surgery center, for patients on employer, individual market or federal employee plans. Medicare, Medicaid and TRICARE, office visits, in-network claims, scheduled care under a signed consent waiver, and coverage or medical necessity denials don’t qualify.
03What does Spectare charge?
Nothing upfront and no setup fee. Our fee is a share of what we recover above the payer’s first payment. It is due only once the payer’s money reaches you.
04What do we need to provide?
Remittances: the 835 files your clearinghouse already produces, EOBs, or read-only access to your billing system. Then one signed authorization so we can file for your group, and a business associate agreement before any patient data changes hands.
05Does this put my patients in the middle?
No. The No Surprises Act already caps what the patient owes at in-network cost sharing. A dispute is strictly between the practice and the payer, and the patient's bill does not change no matter who wins.
06What happens if a dispute is unsuccessful?
You owe nothing. We pay the federal filing fee and absorb the arbiter’s fee, so a dispute that loses costs your practice nothing.
07How long until we see money?
About five to six months from the remittance to the award payment when a dispute runs the full course. Payers also settle during open negotiation, which is faster.
08Do we have to change billing systems?
No. We work from the 835 files your clearinghouse already produces, or from read-only access to the system you already use. Nobody on your team enters claims by hand.
09Can we see our claims before committing?
Yes. Send us 90 days of remittance files. Within 24 hours you get a written list of every eligible claim, the deadlines still open, and the recovery we expect. It’s free, and the list is yours whether or not you hire us.
10Could our billing team do this themselves?
Yes. Any practice may file its own disputes. One dispute is manageable; a month of them is a second job. Each claim has its own 30-business-day window, four business days to file once negotiation ends, an arbiter to agree on, an offer to write, and fees due up front. We take that on for a share of what we add, and nothing if we add nothing.
11What if the payer doesn’t pay the award?
The rules give the payer 30 calendar days. Some pay late, and a federal appeals court has held that a practice cannot sue to collect an award. We track every award and follow up until it is paid, including a complaint to CMS when a payer is late. Our fee is due only on money that reaches your account, so an unpaid award costs you nothing.
12Will payers retaliate or drop us from networks?
Disputes are an ordinary, regulated part of out-of-network payment now, with millions filed every year. If you are already out of network with a payer, there is no contract to lose, and many groups use the dispute record as leverage to negotiate a contract on better terms.
08Free claims review
Find out what your claims could be worth.
Send us 90 days of remittance files. Within 24 hours you get a written list of every eligible claim, the deadlines still open, and the recovery we expect. It’s free, and the list is yours whether or not you hire us.
- 01Every eligible claim, and why it qualifies
- 02The deadlines still open on each one
- 03The recovery we expect, before you commit to anything
No patient information is needed for the first conversation.
Request your review