BillingNav wins 66% of NSA disputes
ATLANTA, March 4, 2026 /PRNewswire-PRWeb/ -- BillingNav - a national leader in balance billing defense, No Surprises Act (NSA) support, financial assistance navigation, and direct contracting strategies - has prevailed in 66 percent of NSA Independent Dispute Resolutions (IDRs) over the last two and a half years, showing consistent performance with every release of CMS NSA public use file (PUF) data. The IDR process is often viewed as being biased toward providers, as health plans on average prevailed in only 13 percent of IDR determinations in the first half of 2025. BillingNav's demonstrated success is proof that health plans can do better, much 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, presented clearly and convincingly, and based solidly in legal, medical, coding, and pricing facts. This is evidenced not just by IDR entity determinations, but also by BillingNav's success – twice the national average – at having CMS rule IDR initiations as substantively or procedurally ineligible.
"For too long, typical IDR results have rewarded inflated charges and left health plans feeling like the NSA claim process is a losing proposition that can't be meaningfully influenced because of how the deck is stacked against them," said Rick Hirsch, a founder and Chief Legal Officer of BillingNav. "Our track record demonstrates that when you bring disciplined strategy and compelling analysis backed by credible data to the table, you can level the playing field and dramatically improve outcomes."
Why does this matter? In the first half of 2025, the difference between provider offers and health plan offers was an astonishing $6.4 billion, up from $2.9 billion for all of 2024. Should health plans have prevailed at BillingNav's rate of 66 percent, rather than at the industry average of 13 percent, they would have reduced their 2025 Q1 and Q2 claims expense by $3.4 billion. These potential savings to health plans will be even more significant in future years. In 2024, there were 2.2 million IDR determinations made, more than five times the number of determinations made in 2023. And in the first half of 2025, there were 4.4 million IDR determinations made, nearly five times the number of determinations made in the first half of 2024. Payers - including the largest commercial carriers and Blues plans - have struggled to keep pace. As a result, they are paying more than is necessary, appropriate, or fair for items and services covered by the No Surprises Act.
BillingNav is the answer. Its demonstrated ability to consistently prevail in IDR determinations at 5x the industry average makes it the partner of choice for health plans.
About BillingNav
BillingNav is a leading healthcare advocacy and compliance platform dedicated to balance billing defense, No Surprises Act support, financial assistance navigation, and direct contracting strategies. By combining expert legal guidance with innovative technology, BillingNav empowers plan sponsors and administrators to reduce costs, protect members, and ensure compliance in an evolving regulatory landscape. Learn more by visiting www.billingnav.com.
Media Contact
Bronwyn Petersen, BillingNav, 1 4158945142, [email protected], billingnav.com
SOURCE BillingNav
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