Jacob Selsman

Listen to this article A little known fact: even several-year-old A/R tied to insurer underpayments can be recovered. Healthcare providers leave millions on the table every year due to unresolved underpayments from insurers acting in bad faith. A common misunderstanding is that if an insurer underpayment wasn’t challenged within several months, or missed out on the No Surprises Act (NSA)’s Independent Dispute Resolution (IDR)’s limited timeframe, it is too late to revisit the A/R. These severe underpayments strongly impact healthcare finances. Running an emergency room with less than 25% of fees covered by insurers sounds impossible. Yet, as we have uncovered on our Wall of Shame, physicians often only see mere fractions of the cost of services rendered paid by insurers. Many providers assume that if these underpaid services weren’t followed up on within a few months, they are no longer recoverable. However, depending on the state you operate in and your revenue recovery strategy, there may still be a substantial opportunity to recover that revenue. Allia Group works with healthcare providers to pursue recovery on underpaid insurer obligations, in many jurisdictions, going back as far as ten years. Here’s what providers need to know in regards to how far they can go back in time to recover insurer underpayments. Why Do Old Insurer Underpayments Get Ignored? Underpayments rarely draw urgent attention. Most billing workflows prioritize newly denied claims or current high-dollar services. But underpaid A/R, especially billing from multiple years ago, falls through the cracks for a few key reasons: 1. Reviewing Aging A/R Is Time-Intensive Manual review of old records can overwhelm internal resources. Sorting, identifying, and assessing historical underpayments takes the right datasets and extensive time and staff allocation. Even in the largest teams, the work simply doesn’t get done. 2. IDR Deadlines Are Tight The NSA requires open negotiation and IDR submissions within 30-day windows. If providers miss those deadlines, they often assume the opportunity is gone. However, IDR is only one viable pathway to revenue recovery— individual litigation windows are significantly longer. 3. Litigation Feels Financially Out of Reach Not only are many billing teams unequipped to pursue litigation, hospital systems and physician groups regularly consider litigation financially unviable. In healthcare, even the largest organizations’ finance and legal executives tread carefully around litigation, agreeing it’s costly enough to warrant caution. The fear of unpredictable expenses makes health systems avoid taking legal action, even when it could be a powerful tool for financial recovery. 4. Early Attempts Hit Dead Ends Even when a billing company flags an issue or attempts an appeal, those efforts often stall early. Frequently, where there is no structured escalation process or follow-up strategy, valid underpayments remain unresolved. As a result, significant revenue gaps are created—even when payers clearly failed to meet their obligations by underpaying providers or violating contract terms. How Far Back in Time Can Healthcare Providers Go? The timeframe for recovery depends on the location of the hospital, physician group, or EMS company. Each state sets their own unique statute of limitations on Allia Group’s legal causes of action. This is the timeframe in which a provider can legally pursue recovery on underpaid services. The chart below lists the states with the longest statute of limitations: State Lookback Window Louisiana 10 years New Jersey 6 years Massachusetts 6 years Ohio 6 years Indiana 6 years Tennessee 6 years New York 6 years Kentucky 5 years Illinois 5 years Missouri 5 years Depending on the location of services rendered, providers may be able to pursue reimbursement for care delivered up to 10 years ago, even if they’ve written off the balance or closed the A/R in their system. What Types of Insurer Underpayments Can Be Recovered? A wide range of underpayment scenarios can qualify for litigation-based recovery strategies. Essentially, if a payer paid less than what was owed under a contract or applicable law, that shortfall can be pursued years after the fact. These common situations include: Downcoded services with no clinical justification Improper denial of emergency services or inpatient stays Out-of-network reimbursements manipulated through flawed repricing models Repeated contract violations or rate reductions outside negotiated terms Claims ineligible for IDR due to timing or batching constraints Systemic patterns of underpayment across CPT codes or service types Allia Group’s Difference Allia Group specializes in litigation finance and other tools which mobilize providers to recover revenue tied to old insurer underpayments. Our approach is different from traditional billing or legal services: 1. Sophisticated Data Analysis We apply proprietary algorithms and state-specific legal knowledge to identify recoverable balances. We examine historical billing records, payer behavior, and contractual terms to surface actionable opportunities. 2. Bundled Litigation Model We group underpaid claims across providers, service lines, and CPT codes to build large, compelling cases against payers. This strengthens negotiating power while reducing administrative burden. 3. Litigation Finance Allia covers the costs of pursuing recovery, including legal fees, expert witnesses, data prep, and court costs. 4. Revenue Realization Our model turns closed or aging A/R into new revenue streams. We’ve helped providers identify and recover millions in unpaid balances previously considered unrecoverable. Key Takeaways Many providers miss out on recoverable revenue tied to old A/R because they assume it’s no longer viable for recovery. In many states, providers can pursue legal recovery of underpayments going back up to 10 years. A wide range of underpayment types can be included in litigation-based revenue recovery, not just denied claims. Litigation can offer a broader, more flexible recovery pathway than IDR style arbitrations or appeals. Allia Group helps providers identify, bundle, and finance litigation-based recovery—unlocking millions in lost revenue. Recover Old A/R from Insurer Underpayments with Allia Group – Contact Us Now Want to discover what revenue your healthcare practice could recover from old A/R tied to insurer underpayments? Contact Allia Group for a complimentary consultation to determine your best course of action.

Listen to this article With over 275,000 disputes flooding the IDR system, healthcare providers are drowning in administrative intricacy. For many, a single missed deadline — as short as four days — can mean thousands in lost revenue. The No Surprises Act (NSA) promised fair payment dispute resolution between providers and payers while protecting patients from unexpected out-of-network bills. However, the Independent Dispute Resolution (IDR) process has instead created a maze of challenges for healthcare providers. From complicated administrative requirements to evolving regulations, many providers struggle to recover the reimbursement they deserve. Here’s why a managed IDR service could be the solution your practice needs. The Hidden Complexities of IDR Management Healthcare providers face multiple challenges when managing the federal IDR process independently. The administrative burden alone can overwhelm staff; which can include: Detailed Open Negotiation Notices (ONNs) Maintaining comprehensive documentation Meeting strict deadlines (miss a four-day filing window after the open negotiation period, and you could lose your right to dispute the claim entirely.) Beyond administrative tasks, providers must navigate intricate federal and state regulations that vary by payer, service type, and location. Determining whether a claim qualifies for federal or state IDR processes requires careful analysis of multiple factors, including payer type and service classification. Even claim batching must follow strict rules, such as matching CPT codes and narrow timeframes. Most providers lack the internal resources and expertise needed to manage these disputes effectively. Success in IDR requires sophisticated data analysis, drawing insights from geographic market data, historical billing data, and payer rate data such as the price transparency and IDR public use files. Without advanced analytics and legal expertise, providers often find themselves at a disadvantage when negotiating with powerful payers. The Four Key Challenges of IDR Management While the IDR process was designed to provide a fast and fair method of resolving payment disputes, it has introduced a host of complications that make it difficult for providers to manage effectively. Let’s examine the four key challenges that providers face:  1. Administrative Burden The IDR process demands a series of labor-intensive tasks that can quickly become unmanageable: Filing Open Negotiation Notices (ONNs): This critical step requires generating detailed emails with listings of all services provided, attached supporting documentation, and the correct payer address for the disputed claims. Even minor errors, like sending an ONN to the wrong payer subsidiary, can result in delays or dispute dismissal. Document Management: Providers must maintain comprehensive records of EOBs/ remittances, medical records, and payer correspondence. While these documents are essential for building strong arbitration cases, organizing and tracking them manually can be overwhelming. Timeline Compliance: The IDR process operates under strict deadlines. Missing the four-day window after the 30-day open negotiation period to submit an IDR dispute can lead to disqualification and significant revenue losses. 2. Complex Regulations and Compliance Healthcare providers must navigate intricate federal and state regulations that vary by multiple factors: Eligibility Determination: Each claim requires careful evaluation to determine whether it qualifies for federal or state IDR processes. This assessment considers factors like payer type (commercial vs. other), service classification (emergent vs. non-emergent), and whether self-funded employer plans have opted into state processes. Batching Rules: Claims can only be batched under strict conditions, requiring them to:  Have identical CPT codes or encounter codes Be serviced in the same 30-day window Be grouped under the same plan Regulatory Evolution: The NSA and IDR regulations continue to change, with updates like modifications to the Qualifying Payment Amount (QPA) weight and constantly changing batching rules significantly impacting arbitration outcomes. 3. Resource and Expertise Gaps Most providers face significant challenges in two critical areas: Data Analysis: Successful IDR outcomes depend on data-driven offer rates, requiring sophisticated analysis of: Historical billing data Public data files such as FAIR Health or the IDR public use files Geographic market statistics Without advanced analytics capabilities, providers risk submitting suboptimal offers. Legal Strategy: Effective arbitration requires payer-specific strategies and deep understanding of federal regulations. Providers without dedicated legal expertise often struggle to present compelling cases. 4. Market Volatility Preparedness The risk of being forced out-of-network due to payer contract terminations presents a significant challenge. Providers must be prepared to: Engage in the IDR process immediately after an out-of-network transition Maintain financial stability following terminated contracts Navigate sudden shifts in reimbursement patterns Leverage success in the IDR process in negotiations with payers for in-network contracts How Do Managed IDR Services Transform the Process? A managed IDR service addresses these challenges by providing comprehensive support and expertise: 1. Automated Efficiency Modern IDR services leverage automation to streamline time-consuming tasks. From generating ONNs to tracking critical deadlines and batching claims appropriately, automation reduces administrative burden while ensuring accuracy. This allows your staff to focus on what matters most: patient care. 2. Data-Driven Decision Making Success in IDR depends on making informed decisions. An IDR managed service can: Provide vast amounts of data analysis to determine optimal offer rates Select the most informed IDR entities  Build compelling evidence-based arguments This data-driven approach significantly improves success rates and maximizes reimbursement outcomes. 3. Expert Legal Strategy Combining data analysis with specialized legal knowledge, managed IDR services develop payer-specific strategies that address common tactics used by insurers. Legal expertise ensures all submissions comply with regulations while building strong cases for fair reimbursement. 4. Preparedness for Industry Volatility In today’s healthcare environment, providers must be prepared for contract disputes and potential out-of-network transitions. A managed IDR service helps establish readiness protocols, analyze historical data for revenue opportunities, and develop contingency plans to maintain financial stability during challenging periods. The Allia Group Advantage With over 14 years of experience in payer disputes, Allia Group offers a comprehensive managed IDR solution that stands out in several ways: Litigation-informed strategies that apply proven legal principles to the IDR process Advanced technology that automates eligibility determination, claim batching, and communication tracking Customizable solutions tailored to the unique needs of physician groups, hospitals, and EMS companies Proven results in achieving higher reimbursement rates and improved cash flow for healthcare organizations