Why AMPS › Out-of-Network › No Surprises Act & IDR
Health plans, payors, and TPAs don't need another compliance workflow. They need leverage. AMPS manages No Surprises Act claims and Independent Dispute Resolution for out-of-network claims as a negotiation strategy built to protect plan dollars, not just close files.
NSA performance to date
NSA claims repriced since the law took effect in 2022.
Average savings against billed charges, earned through strategy.
Only ~500 of 68K claims were disputed by providers.
In-house legal and negotiation expertise.
Figures reflect AMPS-managed No Surprises Act claim volume. Of 68,000 claims repriced, only ~500 were disputed by providers — demonstrating the effectiveness of our pricing strategy.
The challenge
When the No Surprises Act took effect in 2022, every payor faced the same decision about their out-of-network claims: invest in the legal infrastructure, negotiation capability, and operational discipline required to manage NSA claims well, or simply pay more to avoid the fight.
Many vendors chose to pay more. Rather than working claims individually and negotiating disputes on their merits, they adopted risk-averse models that lean on higher initial payments to providers in the hope that disputes never materialize.
Healthcare spend increases, and whatever leverage the plan had is gone before the first conversation.
Four years in, health plans are discovering that a technically compliant NSA program can still be an expensive one. The real financial opportunity sits in how disputes are priced, negotiated, and resolved.
Where NSA stands
The federal IDR process has changed repeatedly since 2022, through litigation, fee revisions, portal pauses, and guidance updates. AMPS has managed claims through every phase of it.
NSA protections begin and the federal IDR portal opens. AMPS stands up an in-house legal and negotiation team from day one.
Dispute volume far exceeds federal projections. Litigation and fee changes trigger portal pauses and long backlogs.
Eligibility rules, batching, and fee structures continue to be revised. Plans relying on rigid workflows fall behind.
Providers and their representatives industrialize disputes. Negotiation quality, not process volume, starts to separate outcomes.
The gap between plans that negotiate and plans that pay is now measurable. AMPS operates on more than four years of refined strategy.
Our approach
Every NSA claim moves through a process designed to protect leverage from the first dollar priced, with human judgment at each step rather than a single automated lane.
Claims are priced using our Reference Based Pricing expertise, so the opening position preserves negotiating room instead of surrendering it.
Each claim is evaluated on its own facts. A rural provider dispute is not handled like a metropolitan health system dispute.
Experienced in-house negotiators work the open negotiation period with intent. This is where 93% of disputes are resolved.
When IDR is the right move, our legal team builds the case and submits the offer. Roughly 7% of disputes go this far.
Outcomes feed back into strategy, and plans receive clear reporting on what was disputed, resolved, and saved.
Why AMPS
Most vendors help plans survive NSA claims.
AMPS helps plans win through them.
What sets us apart
We resolve as many disputes as possible through effective negotiation before they reach IDR, treating arbitration as one tool in a broader framework rather than the plan.
"We build our NSA strategy around intentional negotiations that amplify outcomes before disputes escalate."
Not an automated workflow or a generic, AI-generated response package. Every claim is evaluated individually because every claim, provider, and plan is different.
"No Surprises Act disputes aren't one-size-fits-all. Neither is our approach."
Benchmarking methodology, risk tolerance, escalation thresholds. We build the NSA strategy around your plan's preferences instead of asking you to adopt ours.
"We don't force clients into our NSA model. We build an NSA strategy around their goals."
Dedicated legal professionals, negotiators, and operational specialists working NSA cases since the law's inception, with direct oversight and direct accountability.
"NSA expertise isn't outsourced at AMPS. It's embedded within our organization."
Because negotiations begin from a position informed by our Reference Based Pricing expertise, leverage is preserved rather than spent on the first payment.
"Effective NSA negotiations start long before the first phone call. They start with pricing strategy."
Results
Every figure below reflects real AMPS-managed No Surprises Act outcomes.
Case study
An incumbent vendor was discounting out-of-network claims at 29%. On the identical $9.11M in billed charges, AMPS delivered 67%, cutting the plan's allowable spend by more than half across 4,285 lives.
| On $9.11M in billed charges | Incumbent | AMPS |
|---|---|---|
| Discount achieved | 29% | 67% |
| Discount amount | $2,666,185 | $6,104,591 |
| Allowable amount | $6,445,144 | $3,006,739 |
| Per-employee allowable | $1,504 | $702 |
| Additional savings | — | $3,438,405 |
Frequently asked
Resources & insights
Why 93% of NSA disputes should never reach arbitration — and how the real leverage lives in everything that happens before IDR.
Read the insight →Why strategy — not just following the rules — is becoming the new competitive advantage in healthcare cost management.
Read the insight →A highly anticipated rule aims to improve how insurers and providers settle surprise-billing disputes, but payers say it doesn't go far enough.
Read the article →NSA & IDR, Amplified
Bring us a recent sample of your out-of-network and NSA-eligible claims. In one conversation, our specialists will show you where leverage is being left behind, and what a negotiation-first strategy would recover.
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