No Surprises Act (NSA) Arbitration
If your medical practice was underpaid for out-of-network services, your case may fall under the No Surprises Act and its Independent Dispute Resolution (IDR) process — a system meant to protect patients, but one that insurers often use to suppress physician reimbursement. At Kotlar Cohen, we help physicians and medical groups navigate the process from start to finish, challenge unfair payment tactics, and pursue the full value of your work. In the end, we do our best to take as much administrative and financial pressure off your plate as possible by recovering the payments you deserve.
The No Surprises Act was created to stop patients from getting unexpected bills for emergency care or out-of-network services at in-network facilities. Those protections matter. But the IDR process that followed has become complicated, rigid, and, in practice, tilted toward insurers unless it’s handled with precision. Payments come in lower than market reality, negotiations stall, and practices are left doing extra work for less reimbursement.
When you’re already stretched thin, chasing underpaid claims becomes a drain: revenue goes down, overhead stays the same, and your team spends hours navigating timelines, portals, batching rules, and evidence requirements — all while insurers rely on artificially low Qualifying Payment Amounts (QPAs) to justify reduced offers. The financial impact adds up quickly, especially for hospital-based and emergency specialists whose services are frequently subject to NSA arbitration.
That’s where we come in. Our team identifies which claims qualify for IDR, chooses cases with strong recovery potential, and builds compelling evidence packages that show the true value of your services. We strategically batch similar claims to maximize recovery while minimizing fees, and we apply the most current court-driven regulatory standards to strengthen your leverage throughout the process.
No Surprise Act (NSA) Attorneys
At Kotlar Cohen, we’ve been representing physicians and specialty groups in complex payment disputes since 1995. Our board-certified trial attorneys understand healthcare reimbursement at the legal, operational, and strategic level — and we bring that experience directly into the IDR arena.
With deep expertise in No Surprises Act regulations and the rapidly evolving arbitration framework, we help practices across New Jersey and beyond reclaim the payments they’ve already earned.
If you’re seeing low NSA reimbursements or repeated insurer underpayment, speak with our team today to get a clear evaluation and the best possible outcome for your claims.
No Surprises Act FAQ’s
Do I need legal representation for the IDR process?
You’re not required to hire a lawyer for IDR — but representation can make a measurable difference. The process involves strict timelines, evolving rules, and detailed submission requirements. Insurers know how to exploit gaps in documentation or procedure to reduce payouts.
At Kotlar Cohen, we make sure your claims are properly positioned, supported, and filed on time. We build evidence that pushes arbitrators to see beyond the insurer’s QPA and toward the actual value of your care.
What types of services qualify under the No Surprises Act?
The NSA applies to emergency services, post-stabilization care, and non-emergency out-of-network services provided at in-network facilities. This often includes hospital-based specialists such as anesthesiologists, radiologists, pathologists, emergency physicians, neonatologists, and others who may not be contracted with every insurer tied to the facility.
If your services fit this category and reimbursement came in low, there’s a strong chance IDR is an option.
How does the IDR (arbitration) process work?
IDR is a “baseball-style” arbitration system. That means both sides submit a payment offer and supporting documentation, and the arbitrator must pick one of them. The process generally includes:
- Initiating a required open negotiation period with the insurer
- Filing for IDR if negotiations fail
- Submitting your offer and evidence package
- Having a certified IDR entity select the binding payment amount
We handle these steps end-to-end so your team isn’t stuck living inside the portal.
What is the Qualifying Payment Amount (QPA), and why does it matter?
The QPA is a median in-network rate calculated by the insurer for similar services in your geographic area. Insurers often treat the QPA like a ceiling — even when it doesn’t reflect market reality, complexity, or physician expertise.
Recent court decisions require arbitrators to weigh multiple factors in addition to QPA, including provider experience, prior contracted rates, case complexity, and facility characteristics. We build submissions that highlight these factors clearly and persuasively.
How successful is IDR for physicians?
Providers win the clear majority of IDR cases when submissions are strong and targeted. Results improve with the right strategy: choosing claims that qualify, documenting the true value of care, and applying the latest regulatory standards.
Our focus is on positioning each dispute for maximum recovery — not just “filing and hoping.”
How long does the IDR process take?
From negotiation through determination and payment, the process typically spans several months. The timeline includes:
- Open negotiations
- Formal IDR filing and submission
- Arbitrator selection and decision
- Payment after determination
We keep your cases moving, avoid missed deadlines, and make sure insurers don’t drag their feet.
What if the insurer underpays repeatedly or disputes my claim?
Some carriers build underpayment into their standard approach, knowing many practices won’t challenge it. Others dispute claims by leaning on low QPAs or narrowing what they think qualifies.
We counter with strategic claim selection, tightly organized evidence packages, and litigation-informed argumentation that makes disputing your claim harder — and losing it more costly for the insurer.
Can you help my practice decide which cases to file?
Yes — that’s a core part of our work. Not every underpaid claim qualifies for IDR, and not every qualifying claim is worth pursuing. We review underpayments, identify the strongest recovery opportunities, and batch claims intelligently to drive results while keeping costs controlled.