Independent Dispute Resolution Software

How the Technology Works

Finds the right claims

Quickly identifies IDR-eligible claims, and avoids the ones that create risk. Transparent reporting provides real-time insight into each and every claim in the process.

Builds a stronger case

Drafts custom, data-backed support documents and intelligent offers automatically, giving providers clear visibility into the construction of each case.

Files smarter, not harder

Optimizes each step of the process to reduce costs and maximize returns—all with an intuitive workflow that keeps IDR simple for your team.

Claim Identification

Identify the claims that matter, avoid the ones that don’t.

Providers face millions of claims and limited time to determine which ones are worth pursuing in IDR. Our eligibility engine surfaces high-value, often-missed claims that can add up to millions in uncaptured revenue, while also flagging the claims that shouldn’t be submitted.

Benefits at a glance:

Finds complex, easily overlooked revenue opportunities
Filters out ineligible and non-compliant claims
Designed for providers and hospital systems of all sizes

Benefits at a glance:

Learns from prior IDR determinations
Tailors arguments by payer, code set, and IDRE
Generates clean, defensible, fully compliant statements

Custom Position Statements

Data-backed arguments that win claims.

Winning in IDR is rarely about a single factor. It’s about how claim details, payer behavior, IDRE workflows, and market data come together. Pivotal Health’s proprietary engine analyzes millions of data points to build precise, custom position statements designed to perform across a wide range of IDR scenarios.

Intelligence Batching Technology

Reduce fees. Increase returns. Total visibility—no guesswork.

Batching can significantly reduce IDR costs, but only when it’s done correctly and transparently. Our batching engine automatically groups eligible claims according to federal and state rules, maximizing cost efficiency, ensuring compliance, and giving you full visibility into every decision we make.

Benefits at a glance:

Lower IDR fees with smart, compliant batching
Higher returns through optimized groupings
Full visibility into every batching decision

Trusted by Teams Who Live the Work

See how healthcare organizations are using Pivotal to streamline processes, reduce administrative burden, and bring balance to IDR.

“We managed IDR internally for a few years. But as our claims volume expanded and the process evolved, Pivotal simplified our workflow and delivered strong results. It’s been great to have Pivotal scale with us as we grow.”

Jordan Deuink

AVP Business Development

Providence Anesthesiology Associates

“Pivotal Health has proven to be a great partner. The service team have been useful resources, and we have had immediate success.”

Kim Campbell

Practice Manager

Williamsburg EP

“Pivotal Health has always felt more like a true partner than a vendor — straight shooters who deliver results”

Mark Grossman

CEO

Seven Hills Anesthesia

“Pivotal Health has provided us, a small local business, with the tools and support to drive our practice forward and recoup the reimbursement that we deserve for the expert care that we provide.”

Timothy Chilcote

President Kansas Emergency Physicians