The No Surprises Act made IDR complex. We made it manageable.

The challenge

The federal Independent Dispute Resolution process is deadline-driven, high-volume, and unforgiving of error. Manual approaches don’t scale and expose payers to avoidable risk.

Our solution

We designed and built the case-management solution a healthcare payer uses to run the federal IDR process end to end: eligibility screening, deadline and state tracking, offer preparation, and documentation. We continue to provide the regulatory advisory and specialized resources that support that process on an ongoing basis. The platform we license to other payers is built directly on that same proven design, pairing a deterministic engine that governs deadlines and state with AI-assisted intake for the document-heavy first mile. The result: fewer missed deadlines, stronger offers, and a defensible audit trail.

CMS keeps changing the process, and we keep the platform current with it: the batching and remittance-code requirements landing through 2027, and the move off today’s web forms onto the IDR Gateway. Our analysis of what those changes ask of payers sets out the timeline.

Start with the software, then add the team you need

The platform is the foundation of every engagement. Case management is the base, and you add optional modules as you need them. From there, decide how much of the day-to-day work stays with your staff:

• Advise. A Trexin IDR subject matter expert works alongside your team on strategy, process, and offer logic. Your staff runs operations.
• Jump-Start. Our team runs the casework, builds the playbooks, clears the backlog, and establishes baseline measures, then hands a working function to your staff. You end up with the capability rather than a dependency.
• Operationalize. We run the IDR program end to end under agreed service levels, with the option to scale the team through periods of surge volume.

Your health plan keeps governance, settlement authority, and legal review in every case, under all three. What changes is how much of the work your own team does.

Proven in production

Our IDR solution isn’t a concept, and it isn’t a one-off. Health plans run their federal IDR process on this platform today, at volume, and some have handed us the operation to run end to end. The results below come from the engagement the design grew out of, and are a representative example of the improvement the approach can drive.

The clearest signal comes from that engagement: the plan’s win rate climbed from 2% to 34% over roughly two years, rising steadily and moving well above payer industry averages. (For how payer win rates behave against the Qualifying Payment Amount, see our analysis in Winning the IDR Battle.) The same engagement avoided roughly $1.0M in cost over a single six-month period by catching IDR-ineligible disputes before they reached arbitration, and kept submissions on time across every stage of the process.

Every payer starts from a different place, so the lift varies with your starting win rate, case mix, and dispute volume. What this engagement shows is the magnitude of improvement the approach can produce, and that the software and methodology behind it are proven in live, high-volume environments, not just on paper.

The first of our industry solutions

IDR is the first in a growing set of Trexin industry solutions: end-to-end, turnkey offerings built for the realities of a specific market. If you run a regulated, deadline-driven process that is straining under manual effort, the same pattern applies.