Case Study August 27, 2025
Improving IDR Dispute Processing and Automation
Trexin helped a large health insurer conduct an Independent Dispute Resolution (IDR) process assessment to reduce financial risks and enhance operational efficiency.
Business Driver
Our Client’s team was facing a significant influx of IDR requests as a result of the federal government passing the No Surprises Act (NSA), which contains many provisions to help protect consumers from surprise healthcare bills. Our Client was receiving dispute email volumes approaching 12,000 per month. This high volume, coupled with the financial impact of potential duplicate or abusive claim dispute submissions, necessitated an urgent overhaul of their IDR processing system. Trexin was asked to conduct an assessment and provide recommendations in establishing efficient processes, tools, and roles to manage and improve the IDR dispute processing, ultimately helping reduce financial risk and enhance operational efficiency. Trexin’s recommendations further positioned us to move forward with the implementation phase of the project’s automation.
Approach
The three-week assessment phase included stakeholder interviews, workflow documentation, process diagnostics, and the development of a report with actionable recommendations to enhance IDR efficiency and reduce financial risk in IDR claims processing. Trexin led a four-week planning and execution jump-start phase to implement the agreed upon recommendations as documented in the assessment phase. Trexin focused on data accessibility and centralization as well as mapping of all IDR documentation throughout the process to be leveraged for future automation. The execution phase focused on backlog resolution, planning, and discovery as the basis for automation.
Results
By introducing structured oversight and detailed tracking, our Client gained the ability to act decisively and strategically at every stage of the IDR process. Although win percentages have varied since inception, the overall win rate has increased with some periods as high as 32% for the payer. In addition, our Client has been able to have multiple disputes withdrawn or redone based on eligibility requirements that were previously missed. Real-time visibility helps stakeholders withdraw losing disputes before incurring arbitration costs. The ROI of just the withdrawal process alone is $900k saved over 9 months or $100k per month. As a result, Trexin project managed the execution towards automation, which has continued to produce faster resolutions, fewer lost opportunities, and stronger outcomes for our Client.
