01
01
Claim selection
Find the claims worth pursuing.
Recourse reads your claims and remittance data, confirms eligibility, maps every deadline, and prioritizes the disputes with the strongest recovery potential.
IDR that learns
Every result makes the next claim stronger.
Recourse runs every step of IDR, then puts what it learned to work on the next claim.
The full feedback loop
Most IDR systems stop at filing. Recourse learns from what happened.
Because Recourse runs the full process, it sees the claim, the decisions made, and the result. That result improves the next round.
More claims completed
Keep every eligible dispute moving from intake through filing.
More recovered per claim
Use claims intelligence to strengthen the ask and the evidence behind it.
02
02
Submission intelligence
Build the strongest case for each one.
Claims intelligence guides the offer and supporting argument. Recourse assembles the evidence, addresses every statutory factor, and files the complete submission on time.
03
03
Outcome capture
Capture the result.
Recourse records the payer response, determination, award, and recovery, including which arguments the IDRE credited and where the payer conceded.
Applied to the next claim
The result changes the next decision.
What the IDRE credited, where the payer conceded, and what was recovered improve which claims Recourse pursues, what it asks for, and which evidence it puts forward next.
What learning actually means
The next claim starts with evidence from the last one.
Recourse connects every result to the claim, payer, ask, and evidence behind it. Then it puts that lesson to work on the next similar claim.
A claim is decided
Recourse captures the result
Payer behavior
Where the plan conceded
IDRE reasoning
Which evidence was credited
Recovery
What was awarded and collected
The next similar claim
Three decisions get better
Pursue
Rank the next similar claim
Ask
Set the offer with real outcome context
Build
Lead with the evidence that moved the result
That is the closed loop
Every decided claim gives the next one a better starting point.
What the loop changes
Here’s what this means for your claims.
The learning loop improves recovery in two ways: it makes more eligible claims worth pursuing, and gives every completed filing more recovery potential.
01
More claims pursued
Automation lowers the filing threshold.
02
More recovered per claim
Each result improves the ask and evidence.
First lever: claim coverage
Lower the filing threshold. Recover more.
Recourse monitors payment data for IDR opportunities and automates the work from eligibility through submission. That makes smaller claims economical to pursue and opens more of your eligible claim pool.
More claims identified. More disputes completed. More dollars recovered.
What automation changes
Reach deeper into the claim pool.
Automated monitoringAutomated submissions
Lower threshold
Automation makes smaller claims economical to pursue.
Larger claim pool
More eligible claims can move through recovery.
No new work queue for your billing team. Your team handles exceptions while Recourse runs the process.
Second lever: recovery per claim
Winning is not the same as recovering.
Across 5.7 million decided claim lines, a filer's win rate does not tell you how much it recovered. What it asked for does. Finishing more disputes creates the opportunity. A stronger filing strategy increases the value of each one.
What actually moves recovery
Filers sorted by how much they ask for, into four groups of equal claim volume. Dollars awarded for every $1 in the health plan's offer.
Recovery multiple
10x
7.5x
5x
2.5x
2.08x
3.14x
4.08x
9.71x
Bottom quarterSecondThirdTop quarter
asks 2.62xasks 4.27xasks 6.85xasks 19.3x
And the win rate while that happens
88.1%87.1%88.9%76.0%
Increasing ask →
Bottom quarter by ask
88.1%
Win rate
2.08x
Recovered per $1 offered by the plan
Third quarter by ask
88.9%
Win rate
4.08x
Recovered per $1 offered by the plan
Twice the recovery. The same win rate.
RecoveryWhat you collect
=AskNo fixed ceiling
×Win rateCapped at 100%
Win rate has a ceiling. Ask strategy does not.
Recourse strengthens the offer and the evidence behind it, so each completed filing has more recovery potential.
CMS Federal IDR Public Use Files, 2025, out of network emergency and non-emergency. 5,722,651 decided claim lines after removing repeated line items. Filers are provider email domains with 500 or more priced lines, 126 of them. Recovery multiples are computed on the 3,437,726 lines where CMS reports a qualifying payment amount, and are capped at the 99th percentile. Multiples are ratios of offers, not dollar amounts. The relationship between ask and win rate varies by specialty.
Aligned incentives
Contingency, in one sentence.
Our compensation comes only from the recovery we create for your organization.
Contingency, in plain English
We only earn a fee from dollars we recover for you.
No recovery means no success fee.
The success fee is agreed based on the scope and claim profile. It is earned only on dollars Recourse recovers.
See my CMS benchmark →Easy to adopt. Built for healthcare.
Built to fit your operation, not replace it.
Your team keeps working in the systems it already uses. Recourse starts with the standard 837 and 835 files you already produce and runs IDR alongside your current workflow.
- Works from your existing 837 and 835 files
- No new system of record
- BAA available for handling PHI
- Least-privilege access, audit logging, and encryption in transit and at rest
Your IDR report card
We graded all 649 IDR filers. See yours.
Your one-page report card shows six grades, your dollar gap, and what to fix first. Every grade is a percentile against filers who ask as much as you do.
Federal IDR report card
Six peer-graded measures
649 filers graded
Coverage
Are you finding every eligible claim?
Ask
Do you ask for enough?
Execution
Do you finish what you start?
Cost
What does recovery cost?
Conversion
Do strong asks turn into awards?
Consistency
Is it a system, or is it luck?
Your peer position · Your recovery gap · Your first action
We’ll send your one-page report card with your grades, peer position, and recovery gap.