Avertyn is the case system for the plan side of the No Surprises Act. Notices come in, the business-day clocks start, eligibility is checked, the offer is built on the qualifying payment amount, the packet is ready before the window closes — and a person approves every step.
For TPAs, health plans and the teams defending them. No card. Sample data until your BAA is signed.
Sources: CMS Federal IDR supplemental background, Jul–Dec 2025 (85%, 14%, 1,372,563 disputes; Jan–Jun 2025: 1,186,812) · CHIR / Health Affairs, Aug 2026 (median award 445% of QPA). Market figures, not a promise about your book.
The No Surprises Act is a sequence of business-day windows. Most disputes should end in the first one, where there is no fee and no arbiter.
The provider's notice starts a 30-business-day window to agree a payment. Settle here and the dispute is over.
The provider initiates within 4 business days of the window closing; offers are due 10 business days after the IDR entity is chosen. The entity must pick one party's offer — there is no splitting the difference (45 CFR 149.510(b)(2), (c)(5)). Each party pays a $15 administrative fee; the losing party also pays the IDR entity, $425–$800 per single determination in 2026.
Avertyn does not file in the CMS portal for you and is not a law firm. It prepares, counts, drafts and records; your team decides.
Business-day maths with federal holidays, a countdown on every case, reminders by email and on the phone — pushed to the person who owns the case, not a shared inbox.
Each dispute is screened against the eligibility rules and the plan's qualifying payment amount, with a glass-box explanation you can hand to an IDR entity — or a plan sponsor.
Responses, offers and position statements are drafted from your templates and the case record. Each draft shows its reasons; nothing is sent or filed without a person. Money decisions take two people.
Batch related claims, pick the IDR entity, generate the packet, record the portal confirmation. Every action is written to a hash-chained ledger your auditors can read.
A provider's open-negotiation notice or IDR initiation arrives by email to your workspace address, as an upload, or as a photo of the paper notice taken in the app. The fields are read, the clocks start, and a person confirms the case.
Every pre-built response, offer and position statement cites the regulation it relies on and is written for the plan side. Copy one into your library and the platform requires at least 20% of its wording to change before it can be approved or filed.
Templates are starting points, not legal advice.
Ask a question in plain words and get the term, the citation to 45 CFR 149.510 and what it means on the open case — its deadline, its QPA, its numbers.
Initiator scorecards, exposure by employer plan, and how each IDR entity decides — the leverage you bring to a negotiation and the report you bring to a renewal.
Scheduled reports, a defense report per case, and a read-only view for the employer or auditor who asks what happened to their money.
Every action — automated or human — is written to a hash-chained ledger with the actor and the reason. Payment decisions are staged by one person and released by another, who retypes the amount.
Avertyn is built for the people who administer and defend health plans under the No Surprises Act — TPAs, plans and the advisers who work for them. It does not represent providers and it is not a law firm.
Software, not a contingency service: you pay for the disputes you work, and nothing leaves the platform without a person.
Three sliders, public outcome ranges, no sales fantasy. A real exposure report uses your own claims.
Illustrative. Applies public federal IDR outcome ranges (CMS public use files, Peterson-KFF) to the numbers you enter. Results depend on your book, your specialties and the IDR entity.
| On every dispute | Spreadsheet and inbox | A repricer alone | Avertyn |
|---|---|---|---|
| Deadlines | Counted by hand; easy to forfeit | Not their job | Every window, in business days, with alerts |
| Eligibility | Rarely checked | Not checked | Screened on every case, with the reason |
| The offer | Near the demand | A number without a defense | Anchored to the QPA, explained in writing |
| The record | Email threads | Partial | Hash-chained ledger, every contact logged |
| Priced on | Staff time | A share of "savings" | The disputes you work |
Each plan includes a monthly allowance of disputes and a number of writer seats. Readers are free. A dispute is counted once, in the month it is opened, and every charge traces to a line in your usage ledger.
A free exposure report from a claims or remittance export: disputes at risk, likely defaults, dollars above a defensible offer. No card, no sales call — one message back from a person.
We reply from a named person. Nothing is resold.