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Industry Solution

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

A flagship Trexin industry solution for healthcare payers, pairing deep regulatory expertise with our own software to run the federal IDR process accurately, on time, and defensibly, delivered as advisory, as licensed software, or as a fully managed service.

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.

Three ways to work with us

Choose the model that fits how much you want to own:

  • Advisory. Our regulatory experts and specialized resources strengthen and support your existing IDR process.
  • Software. License the case-management platform, built on the same proven design, and run it with your own team.
  • Fully managed (business-process outsourcing). We run the end-to-end IDR process for you, combining our advisory and our software into a single operation we manage under clear service levels. You get the outcome; we handle the work.

Proven in production

Our IDR solution isn’t a concept. The design behind it runs in production today at a healthcare payer processing disputes at volume, and the results there are a representative example of the improvement the approach can drive.

The clearest signal: that payer’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.

IDR win rate, before and after Trexin A representative healthcare payer's independent dispute resolution win rate rose from about 2 percent to about 34 percent over roughly two years with Trexin's solution. Outcomes vary. 2% Before Trexin 34% With Trexin's solution Representative IDR win rate over roughly two years. Outcomes vary.

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 a live, high-volume environment, 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.

See related work →

Proof

2% → 34%
Payer win rate, over ~2 years
~$1.0M
Cost avoidance in six months
15%
Ineligible cases removed pre-arbitration
99.75%
On-time submission, all IDR stages

Let's get your AI to done.

Start with a fixed-scope AI Readiness Assessment: a fast, low-commitment way to find out where AI will actually pay off, and what it takes to get there.

Request an IDR briefing