The partnership gives more than 75 member hospitals access to specialized Independent Dispute Resolution (IDR) support for pursuing fair reimbursement under the No Surprises Act.

NEW YORK: Pivotal Health (Pivotal), the IDR Authority™ and a full-service Independent Dispute Resolution (IDR) platform, today announced a partnership with the Massachusetts Health & Hospital Association (MHA) to bring specialized, responsible IDR expertise and solutions to more than 75 hospital members in the Commonwealth.

The partnership comes as hospitals and health systems face growing financial pressure from rising costs and reimbursement that has not kept pace. Against that backdrop, IDR has become an important avenue for pursuing fair payment on certain out-of-network claims. Managing those processes successfully and responsibly, however, requires specialized knowledge, operational resources and a deep understanding of evolving requirements.

“The federal IDR process is a crucial tool for protecting patients from out-of-network billing issues, but it can be a complex and challenging process for healthcare providers to navigate,” said Dan McHale, MHA’s senior vice president of healthcare finance & policy. “Pivotal brings clarity grounded in real-world experience and a proven record of helping Massachusetts providers run compliant IDR efforts.”

Pivotal will serve as the preferred IDR partner for MHA's membership, working with hospitals and health systems to manage eligible disputes and recover fair reimbursement. The company will also provide educational resources to help members understand how IDR works in practice and stay current as policies and requirements evolve.

The partnership builds on Pivotal’s recent work with the Healthcare Association Coalition, which selected Pivotal as the exclusive IDR partner for its National Partnership Program. Through that collaboration, Pivotal provides IDR education, solutions and advocacy support to five hospital associations representing more than 350 hospitals nationwide.

“IDR has become a critical part of provider reimbursement operations, and hospitals and health systems increasingly recognize its role in protecting financial sustainability,” said Max Mangum, CEO and co-founder of Pivotal Health. “Having managed more than 2.5 million IDR claims, we’re proud to bring that experience to MHA so their members can get paid appropriately for the exceptional care they provide to patients.”

Pivotal’s technology-enabled platform supports providers throughout the end-to-end IDR process, from identifying eligible claims and preparing submissions to managing disputes and tracking performance. Today, Pivotal partners with more than 200 hospital-based providers nationwide, delivering an 89 percent win/success rate and a 5:1 return on investment.

To learn more about how Pivotal helps hospitals and health systems, visit pivotalhealth.ai.

About Pivotal Health

Pivotal Health is the IDR Authority™, helping providers achieve fair reimbursement with its compliant, full-service Independent Dispute Resolution (IDR) platform. Purpose-built to manage the end-to-end IDR process through technology and expertise, Pivotal partners with more than 200 hospital-based providers nationwide to run IDR at scale and reduce administrative burden on their teams.

About the Massachusetts Health & Hospital Association

The Massachusetts Health & Hospital Association (MHA) serves as the unified voice for Massachusetts hospitals and healthcare providers. Founded in 1936, MHA represents over 100 hospitals, healthcare partners, and patients across the state. Through advocacy, education, and collaboration, MHA’s mission is to improve the overall health of the Commonwealth and support providers’ efforts to offer high-quality, affordable, and accessible care.

Fonte: Business Wire