NSA/IDR Clinical Value Dossier
Physician-authored dossier for No Surprises Act Independent Dispute Resolution proceedings. Every statutory factor addressed. Every arbitrator concern anticipated.
The No Surprises Act created a federal arbitration right for out-of-network payment disputes. The arbitrator reviews submissions from both parties and selects one offer — there is no middle ground. The quality of the clinical submission is the only variable entirely within the provider's control.
Clinovian addresses all six statutory additional circumstances with QPA analysis, clinical complexity narrative, and indexed exhibits. IDR disputes can be batched — multiple claims from the same payer, same CPT category, and same 30-business-day window submitted as a coordinated proceeding.
Provider training & experience
Board certification, subspecialty training, and quality/safety outcomes relevant to the disputed services.
Patient acuity & complexity
Clinical complexity, comorbidity burden, and severity markers that justify the billed amount relative to the QPA.
Teaching status & case mix
Teaching hospital designation, case mix index, and the resource intensity associated with the practice setting.
Good faith demonstrations
Prior contracting attempts, negotiation history, and evidence of efforts to reach agreement.
Prior contracted rates
Historical rate evidence if prior contracts existed between the parties.
Market rate benchmarking
Geographic, specialty, and complexity-adjusted benchmarks that contextualize the provider's offer relative to market rates.
IDR is the fastest path to a measurable result.
Per-case engagement. No long-term contract. The determination timeline is measurable.