BillingNav achieved a 66 percent win rate in No Surprises Act IDR disputes - nearly four times the industry average.
ATLANTA, Sept. 4, 2025 /PRNewswire-PRWeb/ -- BillingNav, a national leader in balance billing defense, has achieved an industry leading 66 percent win rate of No Surprise Act (NSA) Independent Dispute Resolutions (IDRs) over the last two years. The IDR process is often viewed as being biased toward providers, as health plans on average prevailed in only 17 percent of IDR determinations in 2023 and 2024. BillingNav's demonstrated success is proof that health plans can do better than the industry average.
BillingNav's proprietary approach seamlessly integrates the BillingNav Command™ platform, AI analytics, deep hospital policy and pricing expertise, comprehensive medical and claim coding knowledge, and expert legal strategy to deliver compelling, fact-based briefs for each NSA dispute. Through this unique combination of people, process, tools, and expertise, BillingNav consistently delivers to IDR entities appropriate offers based on legal, medical, coding, and pricing facts.
"We drew on decades of experience challenging indefensibly overinflated billing charges and determining fair and appropriate reimbursement to develop an optimal strategy for winning in No Surprises Act IDR disputes on behalf of our client health plans and third-party administrators," said Rick Hirsch, Co-Founder and Chief Legal Officer of BillingNav. "We have clearly proven that with the right expertise and a more sophisticated and customized approach, better outcomes can be achieved for NSA claims than health plans have had over the last few years. BillingNav is the best available solution. Its demonstrated ability to consistently prevail in IDR determinations at nearly four times the industry average makes it the partner of choice for health plans and payers."
Why does this matter? In 2024, the difference between provider offers and health plan offers was an astonishing $3 billion. Had health plans prevailed at BillingNav's rate of 66 percent rather than at the industry average of 17 percent, they would have reduced their 2024 claims expense by $1.5 billion. This potential savings to health plans will be even more significant in future years. In 2024, there were 2.2 million IDR determinations made, six times the number of determinations made in 2023. While CMS has yet to release 2025 data, every expectation is that the number of IDR determinations will continue to grow exponentially. Payers - including the largest commercial carriers - have struggled to keep pace. As a result, they are paying more than is necessary, appropriate, or fair for out-of-network emergency services.
BillingNav's demonstrated ability to consistently prevail in IDR determinations at nearly four times the industry average makes it the partner of choice for health plans.
Media Contact
Bronwyn Petersen, BillingNav, 1 4158945142, [email protected], www.billingnav.com
SOURCE BillingNav
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