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Hospitals & Health Systems IDR Solution
Since the No Surprises Act, hospitals and health systems are navigating increased reimbursement pressure, administrative complexity, and inconsistent payer outcomes across service lines. Our Hospitals & Health Systems Independent Dispute Resolution (IDR) solution works seamlessly with your existing billing infrastructure with zero IT lift to bring predictability back to your payment cycles.

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95%

Success Rate

99%

Client Retention

5-10x

Lift on Initial Payment

Tangible Results For Hospitals & Health Systems

Your Goals Drive Our Approach
Whether you're optimizing out-of-network compensation or planning in-network transitions, we align our strategy with your priorities.
Accelerated Resolution
While IDR typically takes 5-6 months², our hospital & health system clients typically get reimbursement in about 6 weeks.
95% Success Rate
Our historical claims data, IDRE / payor intelligence and custom recommendations strengthen your hospital claims with evidence and context.
Why Hospitals & Health Systems Need IDR
Your Reality Today
No Provider Selection: Patients rarely choose their hospital, leaving hospitals and health systems vulnerable to systematic insurer underpayment.
Reduced QPAs: Payors calculate qualifying payment amounts (QPAs) based on median in-network rates, which are often low.
Scalability Constraints: Billing teams within health systems often lack the specialized knowledge, latest technology, and market intelligence required to pursue IDR at scale.
Your Reality with Pivotal
Genuine Alignment: We only get paid when you do. Pivotal earns solely based on net new revenue generated for your practice. No contract lock-ins, no exclusivity.
Fair Compensation Standards: Our commitment to sustainable, ethical IDR delivers 5-10x original reimbursement rates on average, without abusing the IDR process.
Reclaimed Team Capacity: We handle the IDR process end-to-end, letting your staff refocus on business and clinical operations.
Revenue Predictability: Receive payment in 45 days on average, under one-third the typical timeline¹ so that you can plan your budget confidently.

How Our Hospitals & Health Systems IDR Process Works

Seamless Integration

  • Simple 835 + 837 file feed
  • Automated claim identification
  • Zero operational disruption

Strategic Evaluation

  • Comprehensive underpayment review
  • IDR eligibility validation
  • Evidence-based case development

Expert Execution

  • Professional submission handling
  • Comprehensive deadline and documentation oversight
  • Strategic payor response management

Superior Results

  • 95% average success rate
  • ~45 days average IDR duration
  • Full claims visibility through your dashboard
What Sets Pivotal Apart for Hospitals & Health Systems IDR
Aligned Incentives
Our contingency structure bases compensation on net revenue after you're paid, with zero-capital-outlay options available. Your success defines our success.
Rapid Deployment
Launch within 2 weeks through direct billing feed integration. Zero IT requirements, zero training, and zero workflow interruption.
Market-Leading Performance
Our 95% success rate comes from analyzing proprietary claims data. We understand payor strategies and IDRE selection, and have the insights to help you secure fair compensation.
Total Process Visibility
Your IDR Client Portal operates 24/7, tracking every dispute, payment, and outcome metric. Complete transparency eliminates uncertainty and creates revenue predictability.
Authentic Scalability
Expand from hundreds to thousands of monthly claims without hiring. Our platform manages complexity while your team maintains clinical focus.
Responsive Expertise
Your dedicated success team provides white-glove onboarding and rapid response times. No call center maze, no bureaucracy. Just a dedicated Client Success Manager who understands your account and delivers outcomes.
Ready to put fair back in reimbursement?

For health systems committed to fair reimbursement, Pivotal Health's IDR platform recovers your rightful compensation.

Get Your Free IDR Assessment
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Citation: [1] Explainer: Federal independent dispute resolution process for surprise medical bills  Citation: [2] EDPMA Data Analysis: No Surprises Act Independent Dispute Resolution Effectiveness

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