A Turnkey No Surprises Act Solution

The No Surprises Act has fundamentally changed the landscape for out-of-network healthcare providers, often leaving you underpaid and overwhelmed. With insurers holding the upper hand, navigating the Independent Dispute Resolution (IDR) process can feel like an uphill battle. But it doesn't have to be.

What Is NSA ClearPath?

NSA ClearPath is proprietary technology designed to automate and optimize the IDR process, ensuring fair compensation for healthcare providers

Automates the IDR Process:
Simplifies claims submissions, removing manual errors and inefficiencies
Provides Unmatched Accuracy
and Transparency: Clear data and actionable insights keep you in control
Scales to Your Needs: Whether you're a single provider or a large healthcare system, we can handle your claims volume seamlessly
Delivers Quick Implementation:
In just three weeks, we'll have your system up and running with minimal involvement from your team

Why Choose NSA ClearPath?

Higher Win Rates
Our advanced tools and expert guidance consistently deliver higher win rates compared to manual processes or competing solutions
Transparency and Trust
You'll have access to every data point, performance metric, and process update, ensuring complete confidence in your outcomes
Flexible, Scalable Solutions
No matter your practice size or complexity, NSA ClearPath adapts to your needs and grows with you
Minimal Disruption
All we need is your claims data, payer remittances, and a few guided discussions. We take care of the rest
Commission-Based Structure
We handle every step of the No Surprises Act dispute process for you — from start to finish — covering all associated expenses. All we need from you is the relevant claims data

How have we done?

Top 10

Initiator of Federal NSA disputes

$80M

in 2024 arbitration winnings

3 weeks

from sign-up to implementation

50%

price savings using our NSA support tool vs internally developed process

16%

higher win rate than competitors

Other Products

Risk Sharing Contract Management

A move away from fee-for-service can create enormous opportunities for health systems, but also requires attention to detail: a single non-adhering physician, or overbooked imaging center, can cause havoc. Additionally, payers can often destroy gainshare through bad-faith interpretations of a contract. We track your performance in real-time, provide outputs to all stakeholders including physicians, and link that performance to overall gainshare to avoid nasty surprises.

Contract Negotiation

The largest insurers have developed sophisticated national infrastructure to drive down costs as much as possible - for example, United pays out $250B annually which is roughly 1,000 times the total income of the average hospital. We provide legal and technical sophistication to benchmark your rates against multiple sources including price transparency, quantify how obtuse contract lines will actually affect your revenues, and redline any qualitative contract language that could be used against you.

Proactive Contract Monitoring

Insurers who can’t win discounts through aggressive negotiation often resort to increasingly sophisticated revenue cycle tricks, such as denials or underpayments hidden in obtuse 835 adjustment reasons and justified through benign-looking contract language. We monitor your billing and remittances to immediately catch these changes, allowing immediate pushback before months of losses have accrued. And if it comes down to it – we have a close working relationship with a top tier provider-focused law firm that frequently wins cases against the biggest insurers in the country.

Successes

Our track record speaks for itself

>$200M

Earned for our clients across our products

1-3%

Increased revenue through proactive monitoring of your reimbursement

Top 10

Initiators of Federal No Surprises Act disputes

50%

Savings using our no surprises act tool vs. internally developed processes

5%

Increase in FFS managed care rates with our price negotiation solution

Who we are

Matching and overcoming the capabilities of a payer’s multi-billion-dollar contracting department requires some techniques

A Big Tent Team

Our company consists of provider and payer-side healthcare market leaders, top-tier provider side managed care litigators, clinicians, and cutting edge developers. Combining those vastly different viewpoints into a coherent solution is what makes us special.

Technical decisions made by the right people

Everybody is now using the same servers - United/Optum uses AWS. The key differentiator is the software, and we live in a time when either misunderstanding a business need, or a mistaken hyper-detailed technical decision (Python 2.7 or 3.2!) can spiral into to a weeks-long headache for a CEO. While large insurers have multiple layers of bureaucracy, we make our choices unencumbered by decades of legacy systems or demands of tangentially related VPs.

Convenient Solutions

Switching to a new system doesn’t have to be hard. We connect our core software to your existing processes quickly and simply through temporary streamlined work flows; then build out a mature integration to your systems in a way that saves us all time and effort. Our goal is to minimize the full cost of your solution, which includes your time, resources, and focus

Product

Risk Sharing Transparency

Combine Clinical and Financial Implications

A move away from fee-for-service can create enormous opportunities for health systems, but creates many possible points of failure: some misaligned incentives, a non-adhering physician, or an overbooked imaging center can cause havoc. Additionally, payers can often destroy gainshare through bad-faith interpretations of a contract.

Addressing the Issue

Addressing these issues before they grow requires a lot of hard work and timely interventions. Those interventions require fresh and detailed data, and rapid turnaround of analytics on that data

Identify gaps in care leading to patient complications or avoidable spend

Track performance of all gainshare participants to determine positive or negative trends

Develop new interventions or map existing interventions to patient populations and communicate to stakeholders their financial impact of performing those interventions

Regularly update gainshare performance for the system as a whole against payer-calculated metrics

Stay on Top

By staying on top of your performance and transparently tracking successes of all stakeholders, we keep the details straight, participants aligned, and avoid any nasty surprises.

Product

Contract Negotiation

Win Negotiations Against The Largest Insurers

The largest insurers have developed incredibly sophisticated national infrastructure to drive down costs as much as possible - for example, United pays out $250B annually in “medical loss” which is roughly 1,000 times the total income of the average hospital - so they can spend enormous sums developing methods to outsmart hospitals and reduce those payouts.

These insurers know how much hospitals earn from other insurers; how much revenue is being clawed back from providers through denials and underpayments; and stay abreast of opportunities to shift volume to lower-cost providers through narrow networks, patient education, or redirection.

We can respond to these insurers with equal force

Price transparency data quantifies your competitors' negotiated rates with each insurer

Sophisticated modeling tools accurately determine expected reimbursement from the most inscrutable contracts

Legal review of contract language identifies and avoids negative contract language

Targeted increases into into growing service lines drives revenue gains beyond payer-calculated amounts

By considering all aspects of a contract in tandem, we can get you a deal that will lead to increased realized revenues, and not just a higher rate on a piece of paper that is clawed back through denials.

Product

Proactive Contract Monitoring

Staying on Top of Payer Tricks

As the cost of health care rises and Medicare/Medicaid rates remain flat, the negotiations between payers and providers have gotten increasingly hostile. Where insurers can’t win discounts through aggressive negotiation they often resort through increasingly sophisticated revenue cycle tricks, such as denials or underpayments hidden in obtuse 835 adjustment reasons and justified through benign-looking contract language.

We monitor your billing and remittances to immediately catch these changes, allowing immediate pushback before months of losses have accrued. And if it comes down to it – we have a close working relationship with a top tier provider-focused law firm that frequently wins cases against the biggest insurers in the country.

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