When the No Surprises Act took effect in 2022, the industry did exactly what it should have. Health plans, TPAs, brokers, employers, and the vendors serving them put their energy into understanding the regulation, building the processes, and proving they could meet the requirements. Compliance was the right objective.

Today it's an incomplete one.

After several years of watching how organizations adapted, the pattern is hard to miss. Compliance alone does not create value, and in plenty of cases it doesn't even produce a better outcome. What separates the organizations merely managing NSA disputes from the ones getting real results isn't their ability to follow the law. It's what they do once compliance is no longer in question.

The first response was understandable

When a regulation this consequential lands, uncertainty follows, and organizations reach for risk reduction. A lot of the early NSA strategies were built around a single objective: avoid disputes wherever possible. That meant higher initial payments, more rigid processes, less negotiation, and less room to maneuver. The logic was that fewer disputes would mean less administrative drag.

Reality has been less cooperative. Avoiding disputes rarely produces the strongest financial result, and it often surrenders negotiating leverage before the conversation has even started. The question worth asking has quietly shifted from "Are we compliant?" to "Are we getting the best possible outcome?" Those are two very different conversations, and extremely important realities to face.

Not every claim requires the same strategy

The most common assumption I run into is that NSA disputes should move through one standardized process. On paper that sounds efficient. In practice, healthcare is rarely that tidy.

A pediatric specialty claim raises different questions than a trauma case. A rural hospital negotiation looks nothing like a dispute with a large health system. Every provider relationship, every geographic market, every patient circumstance changes the variables. The organizations getting the strongest outcomes treat each situation on its own terms and adjust the approach accordingly.

Our own results bear this out. Of the claims that draw provider pushback and move into active dispute, our in-house team settles 52% through negotiated settlements and resolves another 41% through provider write-offs. Only 7% ever reach Independent Dispute Resolution (IDR). That spread isn't an accident. It's what happens when each claim is read on its merits instead of forced through the same lane.

Most disputes are won before IDR ever starts, not by industry norm

Across the industry, much of the NSA conversation centers on arbitration, through which providers are winning 88% of the time. Arbitrators are awarding payments that average 450% of in-network rates. IDR administrative costs hit $844 million in the first half of 2025 alone. Every dollar paid out above a defensible in-network equivalent is a dollar that erodes plan margin, inflates medical loss ratios, and ultimately contributes to premium pressure that employers and members feel.

Which is why arbitration is not a strategy. It's one piece inside a much larger process, and the real opportunities tend to show up well before it ever comes into play: in preparation, in positioning, and in the negotiation itself.

That's why so few of our disputed claims end up in front of an arbitrator. When they do, we earn favorable determinations 80% of the time. The bigger story, though, is everything we resolve before reaching that point. Across all NSA claims we've repriced, this approach has produced average savings of 75.5% against billed charges. The industry standard sits around 35.5%. We're delivering more than double that.

Technology helps. It accelerates workflows, improves visibility, and takes administrative weight off the team. What it doesn't do is replace judgment. Our legal negotiations team averages 21.5 years of healthcare experience across provider systems, payer environments, TPA operations, and legal practice, and that depth is what turns a defensible position into a better outcome. Tools don't negotiate. People do.

Why We've Been Able to See the Industry Differently

The perspective shared here isn't theoretical.

It's been shaped by years of working alongside brokers, TPAs, health plans, payors, and self-funded employers navigating the realities of the No Surprises Act every day.

PriceDynamix, the medical claims repricing solution of AMPS sits at the intersection of strategic claim and network repricing, provider negotiations, legal expertise, and payment integrity. That vantage point provides a unique perspective into how NSA disputes evolve, where opportunities are often missed, and what consistently produces stronger financial outcomes.

Rather than building our approach around compliance alone, AMPS invested early in developing an integrated strategy that combines strategic pricing methodologies, experienced legal professionals, dedicated negotiators, and operational expertise. Each discipline strengthens the next, creating a connected model designed to protect plan dollars while maintaining the flexibility to evaluate every claim on its own merits.

That integrated approach has enabled AMPS to reprice nearly 68,000 NSA claims, deliver an average 75.5% savings against billed charges, resolve 93% of provider disputes before reaching IDR, and achieve an 80% favorable determination rate when arbitration becomes necessary.

Those results aren't simply operational metrics.

They're evidence that approaching NSA as a strategic discipline rather than an administrative requirement can fundamentally change financial outcomes for payors, and employer-sponsored health plans alike.

Where the advantage is going

The NSA isn't new anymore, and the industry's understanding of it is maturing. As it does, the gap is widening between organizations that treat NSA as a compliance function and those that treat it as a strategic discipline.

The ones pulling ahead aren't necessarily the ones with the most technology, the largest teams, or the most rigid playbooks. They're the ones who stopped asking how to avoid disputes and started asking how to better approach them. They've learned to read each claim on its merits, to lead with negotiation rather than default to arbitration, and to treat every dispute as what it actually is: a chance to protect plan dollars and strengthen the financial result.

Back in 2022, the instinct was to find a way out of disputes. And to do it quickly. A few years inside this work has convinced me that's the wrong reflex entirely. The disputes aren't something to escape. They're where the very best outcomes get decided.

Michael Condon

SVP & GM, PriceDynamix

Michael Condon serves as SVP, GM for PriceDynamix, the medical claims repricing solution of AMPS. In this role, he works closely with brokers, TPAs, health plans, and self-funded employers to develop innovative payment strategies that reduce healthcare costs, protect plan assets, and improve financial outcomes. Through PriceDynamix and the broader AMPS ecosystem, he helps organizations navigate the complexities of the No Surprises Act with a strategy built around negotiation, flexibility, and long-term value creation.

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