Your revenue cycle, handled. Your attention, back on patients.

Ascendix Billing Solutions LLC runs medical billing and revenue cycle management for small, large and multi-specialty practices across the U.S.: PCPs, nurse practitioners, surgeons and assistant surgeons, surgical centers, ambulatory surgery centers and emergency care centers. We take the claims, the calls and the payer disputes off your desk, so your team can focus on patient care.

Request a free RCM assessment

Registered New Jersey LLCServing providers since 201630 EHR & PM platforms30 specialties

Now atCredentialing

The showroom

Walk through what we do, one room at a time.

Each room is a full page. Open the one that matches what is keeping you up at night, or use the Menu button at the top to see everything at once.

Services

Fourteen services across the revenue cycle, from credentialing and coding through denials, A/R and payment posting. Take the whole cycle or just the stage that hurts.

Billing & coding
End-to-end RCM
Credentialing
Denials & appeals
A/R recovery
Payment posting

Open this room

Federal NSA IDR

Out-of-network emergency and facility-based claims paid below value can go to federal Independent Dispute Resolution. We run the whole case.

Open negotiation
IDR initiation
Offers

Open this room

State arbitration

When a state-regulated plan or a no-fault carrier underpays, the dispute goes through the state. We know which door to knock on.

NY
NJ
TX
CA
PIP

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Payer programs

In-network, out-of-network, PIP and MVA, workers' compensation, patient self-pay. Each has its own rules, forms and deadlines.

In-network
Out-of-network
PIP / MVA
Workers' comp
Self-pay

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Specialties

Thirty specialties, from primary care to neurosurgery, each with its own coding patterns and denial habits.

Primary care
Surgical
Behavioral
Diagnostic

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Technology

Thirty EHR and practice management platforms. We work in yours, not the other way round.

Epic
athenahealth
eClinicalWorks
NextGen

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About Ascendix

A New Jersey limited liability company serving providers since 2016. Detail-oriented teams organised by function, so the person working your denials does nothing but denials.

Since 2016
Registered LLC
Function-based teams

Open this room

What changes when billing leaves your desk

Less time on hold with payers. More time with patients.

Billing in-house, stretched thin

Front-desk staff chasing denials between check-ins
Claims aging past 90 days because nobody owns follow-up
Out-of-network underpayments accepted because disputes look too complicated
Month-end reports that show totals but not reasons
Providers finishing charts and billing questions at night

Billing with Ascendix

A dedicated team owns every claim from charge to payment
Aging A/R worked on a schedule, payer by payer
Eligible underpayments taken to federal IDR or state arbitration
Monthly reporting that explains what happened and why
Your staff back at the front desk, your providers back with patients

The cycle we run

Eight stages. One accountable team.

A claim passes through every one of these, in this order. A gap at any stage costs you money later. We cover all of them, or slot in where your team needs support.

Credentialing & enrollment
Your providers are set up with every payer before the first claim.
Eligibility & authorization
Coverage and prior auth checked before the patient arrives.
Coding & charge entry
Accurate codes and the right modifiers, first time.
Scrub & submit
Claims checked against payer edits before they leave.
Denials & appeals
Every denial worked to the root cause, then appealed or corrected.
Posting & A/R
Payments reconciled, underpayments flagged, aging accounts chased.
Disputes
Out-of-network underpayments taken to federal IDR or state arbitration.
Reporting
A monthly read-out you can actually understand.

See every service in detail

Payer programs

In-network or out, auto injury or workplace, insurer or patient.

We bill and follow up across every way a practice gets paid.

In-network

Contracted payers, timely filing, underpayments against your fee schedule.

Out-of-network

Negotiation, appeals, and federal or state dispute resolution.

PIP / MVA

Auto-injury claims, no-fault forms and carrier follow-up.

Workers' comp

Authorizations, state fee schedules and bill disputes.

Patient & self-pay

Clear statements and respectful follow-up.

Technology

We already know your system.

Hands-on experience across hospital, enterprise and ambulatory platforms.

EpicOracle HealthMEDITECH ExpanseathenahealtheClinicalWorksNextGenVeradigmGreenwayAdvancedMDCureMDDrChronoTebraCareCloudModMedPractice FusionElationRXNTWellSkyNetsmartTruBridgeAlteraMEDHOSTPrognoCISMeditabMicroMDMediFusionChartLogicPraxis EMRICANotesSimplePracticeTherapyNotesEpicOracle HealthMEDITECH ExpanseathenahealtheClinicalWorksNextGenVeradigmGreenwayAdvancedMDCureMDDrChronoTebraCareCloudModMedPractice FusionElationRXNTWellSkyNetsmartTruBridgeAlteraMEDHOSTPrognoCISMeditabMicroMDMediFusionChartLogicPraxis EMRICANotesSimplePracticeTherapyNotes

Platform names are trademarks of their respective owners and are listed to describe our team's working experience. No partnership, certification or endorsement is implied. See all 30 platforms

Federal IDR results

Insurance paid hundreds. IDR awarded thousands.

Since 2023 our disputes team has managed more than 2,000 federal No Surprises Act disputes for surgeons, pain physicians, vein specialists, neurosurgeons and surgical centers. Three examples:

2,000+federal IDR disputes managedJanuary 2023 to present

96%+win rate on decided disputesacross payers and IDR entities

$78M+won for providers through IDRsince the start of 2023

12certified IDR entities argued beforeincluding C2C, Capitol Bridge and Maximus

Vein & vascularProvider prevailed

Endovenous ablation

Ambulatory surgery center. National commercial insurer. Decided 2025.

36475

220×the plan's initial payment

Initially paid$285.62

IDR award$62,699

Interventional painProvider prevailed

Lumbar epidural & nerve blocks

Ambulatory surgery center. National commercial insurer. Decided 2025.

644836448464450

186×the plan's initial payment

Initially paid$292.64

IDR award$54,364.50

Spine surgeryProvider prevailed

Two-level lumbar discectomy

Outpatient hospital. Regional Blue Cross Blue Shield plan. Decided 2025.

6303063035

61×the plan's initial payment

Initially paid$1,968.55

IDR award$121,000

Portfolio figures are Ascendix's own records for federal IDR disputes managed from January 2023 to the present. The examples are selected, de-identified determinations from that portfolio; patient, claim and practice identifiers are removed. An IDR award is the out-of-network rate set by a certified IDR entity; the plan then pays that amount less its initial payment and the patient's cost sharing. Past results do not guarantee future outcomes, and every dispute depends on its own facts and documentation.

See more case examples Request an IDR eligibility review

Provider testimonials

Our history of work, in our providers' words.

4.9

Average from 7 provider reviews across family medicine, pediatrics, chiropractic, pain medicine, foot and ankle surgery and neurosurgery.

5.0

We switched to Ascendix after years of juggling billing in-house. Denials are now worked every week instead of piling up, and our preventive and sick visits on the same day are finally coded correctly. Their monthly report is the first one I actually read. My staff is back at the front desk, where they belong.

Dr. Mohamed SulemanMS Family Medicine, California

5.0

Pediatric billing is vaccines, screenings and well visits, and small errors add up fast. The Ascendix team caught vaccine administration and modifier issues our previous biller had missed for years. They are responsive, patient with our questions and explain everything in plain language. I recommend them to every pediatric practice I know.

Dr. Naveen ElkholyComprehensive Pediatrics, New Jersey

4.5

No-fault and PIP claims used to be our biggest headache. Ascendix took over the carrier follow-up, the forms and the arbitration referrals, and accounts we had given up on started coming back as payments. Communication is consistent, and they always know exactly where each claim stands.

Dr. Robert SusinSusin Chiropractic, New York

5.0

Between auto injury, workers' comp and commercial insurance, our payer mix is complicated. Ascendix keeps every case straight and bills the right payer in the right order. Collections are steadier month to month, and I spend my day treating patients instead of chasing adjusters.

Dr. Charles SantoroSantoro Chiropractic, New Jersey

5.0

Pain management depends on prior authorizations, and Ascendix has them lined up before our procedures. Denials are worked the same week they arrive. They also handled our out-of-network disputes through the federal IDR process with real attention to every deadline. Professional, detail-oriented and easy to reach.

Dr. Muhammad AliPain Medicine, New Jersey

4.5

Surgical billing with global periods and multiple procedures needs people who know what they are doing, and the Ascendix coders do. Our claims go out cleaner, and when a payer underpays an operative claim, they follow it all the way through. A dependable partner for a busy surgical practice.

Dr. Emad IssaFoot & Ankle Surgery, Texas

5.0

Complex spine cases and high-value out-of-network claims are where billing mistakes cost the most. Ascendix reviews every operative claim carefully and has been persistent with appeals and IDR disputes. I trust them with the revenue side so I can stay focused on surgery and on my patients.

Dr. Syeda HumairaNeurosurgery, Houston, Texas

5.0

Pediatric billing is vaccines, screenings and well visits, and small errors add up fast. The Ascendix team caught vaccine administration and modifier issues our previous biller had missed for years. They are responsive, patient with our questions and explain everything in plain language. I recommend them to every pediatric practice I know.

Dr. Naveen ElkholyComprehensive Pediatrics, New Jersey

Pricing at a glance

Four ways to work with us.

Final pricing depends on specialty, claim volume, services, payer mix and scope, and is confirmed in a written agreement before any work begins.

Most complete

Percentage of collections

5–7%

of monthly collections

We are paid when you are paid. Best for practices that want billing off their plate entirely.

Full end-to-end RCM
Coding, claims, denials and A/R
Payment posting and reconciliation
Patient statements
Monthly reporting and review call

Request pricing

Fixed rate

Custom

fixed monthly fee

A predictable fee for a scope of services we agree together.

Choose the services you need
Same fee every month
Scope reviewed as volume changes
Monthly reporting

Request a quote

Dedicated seat

Single

service specialist

One specialist for one function, working only on your account.

Billing, coding, A/R, denial or RCM specialist
Works your queues daily
Supervised by Ascendix leads
Weekly status updates

Talk to us

Remote in-house

Remote

RCM professional

A dedicated professional who works as part of your in-house team.

Works in your systems and processes
Your hours and priorities
Quality-checked by Ascendix
Scale up or down

Hire a specialist

Compare plans, project pricing and referral fee relief

Trust, earned in writing

Every claim is time, resources and care given to a patient. We treat it that way.

A registered New Jersey limited liability company, serving providers since 2016
Scope, pricing and responsibilities agreed in a written service agreement before work starts
Work done inside your own EHR and clearinghouse, under credentials you control
Monthly reporting at claim level, so you can check our work
HIPAA business associate: a BAA before we access any PHI, role-based access and encrypted file exchange
Plain answers on what we cannot promise: no one can guarantee a payer's decision

View company and legal information How we protect patient data

EST.2016

Ascendix Billing Solutions LLC

Medical billing and revenue cycle management

Entity type: Domestic Limited Liability Company
State: New Jersey
NJ entity ID: 0451505185
Registered office: 971 US Highway 202N, Ste N, Branchburg, NJ 08876
Serving providers since: 2016
Serves: Healthcare providers across the United States

Find out where your revenue is getting stuck.

Send us a short description of your practice. A billing specialist will review your setup and come back with what we see, at no cost and with no obligation.

Request a free RCM assessment Call +1 (973) 544-3838

Fourteen services. One revenue cycle.

Take the whole cycle off your desk, or hand us the one stage that keeps going wrong. Every engagement starts with a free assessment and a written scope.

Request a free RCM assessment

End-to-end or à la carteWritten scope before work starts

Medical billing & coding

Accurate claims start with accurate codes. Our coders and billers turn each encounter into a claim that matches the documentation and the payer's rules.

Every specialty we serveProfessional and facility

Charge entry from superbills, encounter forms or EHR charge capture
CPT, ICD-10-CM and HCPCS Level II coding
Modifier review (25, 59, XE/XS/XP/XU, 26/TC, 50, 51, 62, 78, 79 and more)
E/M level review against documentation
Global-period and bundling (NCCI) checks
Coding queries to providers when documentation is unclear

End-to-end revenue cycle management

One accountable team from the day a provider is credentialed to the report that shows where revenue stands. Best for practices that want billing off their plate entirely.

Most complete option

Credentialing, eligibility and prior authorization
Coding, charge entry and claim scrubbing
Electronic and paper claim submission
Rejection, denial and appeal management
Payment posting and reconciliation
A/R follow-up, underpayment recovery and patient statements
Monthly performance reporting and review calls

Credentialing & payer enrollment

No enrollment, no payment. We get providers set up with commercial, Medicare, Medicaid and other payers, and keep them that way.

New practicesNew providers

CAQH ProView setup, attestation and maintenance
Medicare (PECOS) and Medicaid enrollment
Commercial payer applications and contract follow-up
NPI and taxonomy alignment
Group and location additions, linkages and changes
Re-credentialing and revalidation tracking

Eligibility, benefits & prior authorization

Most avoidable denials begin before the visit. We verify coverage and secure authorizations so the claim is payable before it is created.

Front-end

Real-time and manual eligibility verification
Benefit breakdowns: deductible, co-insurance, visit limits
Prior authorization requests, tracking and extensions
Referral management for HMO and gatekeeper plans
Out-of-network benefit checks for OON providers

Claims management

Submission is not the finish line. We scrub, submit and then track every claim until the payer acts on it.

Back-end

Clearinghouse edits and payer-specific scrubbing
Electronic (837P/837I) and paper (CMS-1500/UB-04) claims
Rejection fixes and same-week resubmission
Claim status checks by portal, phone and 276/277
Corrected and replacement claims
Timely-filing tracking by payer

Denial management & appeals

We find out why a claim was denied, fix it, and fix whatever caused it so the next one is not denied too.

Root cause to resolution

Denial categorisation by reason (CARC/RARC) and payer
Corrected claims and reconsiderations
First and second-level written appeals
Medical necessity and documentation appeals
Trend reporting back to your front desk and providers
Root-cause fixes to templates, workflows and edits

A/R management & underpayment recovery

Old money is still your money. We work aging accounts systematically, oldest and largest first, and catch payers paying less than they owe.

Old A/R projects welcome

Aging A/R clean-up projects (60, 90, 120+ days)
Payer follow-up by phone, portal and correspondence
Underpayment detection against contracted rates
Credit balance and refund review
Write-off review and recommendations
Hand-off of eligible out-of-network claims to IDR or arbitration

Payment posting & reconciliation

Clean books make every other report trustworthy. We post insurance and patient payments and reconcile them to deposits.

Daily or weekly

ERA (835) and manual EOB posting
Patient payment and copay posting
Deposit-to-posting reconciliation
Denial and zero-pay flagging at posting
Secondary and tertiary claim triggering

Out-of-network billing & negotiation

Out-of-network claims are paid by different rules and often underpaid. We bill them correctly and pursue the gap.

Pairs with IDR

Out-of-network claim submission and follow-up
Single-case agreement and negotiation support
Federal NSA open negotiation and IDR (see the IDR page)
State surprise-billing arbitration where state law applies
Patient balance rules under the No Surprises Act

PIP, MVA & no-fault billing

Auto-injury claims follow carrier and state rules, not health-plan rules. We handle the forms, the deadlines and the follow-up.

Ortho, pain, PT, chiro, imaging

Claim setup with carrier, claim number and adjuster details
State no-fault forms and supporting documentation
Carrier follow-up and payment tracking
Denials, IME/peer-review cut-offs and fee-schedule reductions
PIP A/R management and arbitration referral where applicable

Workers' compensation billing

Workplace injury claims need the right case details, authorizations and state fee schedule from the start.

State-specific

Employer, carrier and case number capture
Authorization requests and tracking
State fee-schedule billing
Required report attachments
Carrier follow-up and bill-dispute support

Patient collections & self-pay

Patients pay more of the bill than ever. We make statements clear, offer simple ways to pay and follow up respectfully.

Patient-friendly

Patient statements and reminders
Payment plans set up to your policy
Self-pay estimates and Good Faith Estimate support for uninsured patients
Patient billing questions answered by phone or email
Hand-off to your chosen collection agency, if you use one

Revenue cycle consulting & reporting

Not ready to outsource? We review where revenue is leaking and show you how to fix it.

Assessment is free

Revenue cycle assessment and leakage review
Fee schedule and payer contract review
KPI dashboards: first-pass rate, days in A/R, denial rate
Workflow and staff process recommendations

Dedicated & remote specialists

Need hands rather than a vendor? A dedicated Ascendix specialist works in your systems, on your processes, as part of your team.

Single seat or team

Billing, coding, A/R, denial or RCM specialist
Works your queue in your EHR and clearinghouse
Supervised and quality-checked by Ascendix leads
Scales up or down with your volume

Pricing & engagement models

Four ways to work with us.

See the full pricing page

Final pricing depends on specialty, claim volume, services, payer mix and scope. Everything is confirmed in a written agreement before you start.

Percentage of collections

5–7%

of monthly collections

We are paid when you are paid. Best for full end-to-end RCM.

Request pricing

Fixed rate

Custom

fixed monthly agreement

A predictable fee for an agreed scope of services.

Request pricing

Dedicated seat

Single

service specialist

One specialist for one function: billing, coding, A/R, denials or RCM.

Talk to us

Remote in-house

Remote

RCM professional

A dedicated professional working inside your team and systems.

Hire a specialist

Refer a provider, earn 15% fee relief

Know a practice, clinic or medical group that could use our help? Eligible referrals earn 15% fee relief. Eligibility and terms are confirmed in writing in your service agreement.

Refer a provider

Not sure which service you need?

Most practices are not. Tell us what you are seeing (denials, slow payments, old A/R) and we will tell you which stage is causing it.

Request a free RCM assessment Call +1 (973) 544-3838

Out-of-network and underpaid? Federal IDR exists for exactly this.

The No Surprises Act protects patients from surprise bills and gives providers a formal process to challenge out-of-network payments. Ascendix prepares, files and follows every eligible dispute through to payment.

Request an IDR eligibility review See the timeline

2,000+ IDR disputes managed96%+ win rate on decided disputes$78M+ won since 2023

Case results

2,000+ disputes. 96%+ won. $78M+ recovered for providers.

Out-of-network claims are routinely paid a few hundred dollars. Below are selected determinations from our portfolio showing what the plan paid first and what the certified IDR entity awarded after our team built the case.

2,000+federal IDR disputes managedJanuary 2023 to present

96%+win rate on decided disputesacross payers and IDR entities

$78M+won for providers through IDRsince the start of 2023

12certified IDR entities argued beforeincluding C2C, Capitol Bridge and Maximus

Vein & vascularProvider prevailed

Endovenous ablation

Ambulatory surgery center. National commercial insurer. Decided 2025.

36475

220×the plan's initial payment

Initially paid$285.62

IDR award$62,699

Interventional painProvider prevailed

Lumbar epidural & nerve blocks

Ambulatory surgery center. National commercial insurer. Decided 2025.

644836448464450

186×the plan's initial payment

Initially paid$292.64

IDR award$54,364.50

Spine surgeryProvider prevailed

Two-level lumbar discectomy

Outpatient hospital. Regional Blue Cross Blue Shield plan. Decided 2025.

6303063035

61×the plan's initial payment

Initially paid$1,968.55

IDR award$121,000

Vein & vascularProvider prevailed

Endovenous ablation

Ambulatory surgery center. Third-party administrator (self-funded plan). Decided 2025.

36475

66×the plan's initial payment

Initially paid$694.49

IDR award$46,000

Spine surgeryProvider prevailed

Thoracic spine reconstruction

Hospital emergency department. Regional Blue Cross Blue Shield plan. Decided 2025.

2284322853630466304822610226146308522327

30×the plan's initial payment

Initially paid$9,446.96

IDR award$280,249.63

Interventional spineProvider prevailed

Lumbar decompression & trigger points

Ambulatory surgery center. Regional Blue Cross Blue Shield plan. Decided 2025.

630566305720553

27×the plan's initial payment

Initially paid$3,137.65

IDR award$85,250

Interventional painProvider prevailed

Spinal nerve & facet ablation

Ambulatory surgery center. Regional Blue Cross Blue Shield plan. Decided 2025.

647726463564636

19×the plan's initial payment

Initially paid$2,727.63

IDR award$51,300

NeurosurgeryProvider prevailed

Craniectomy for hematoma

Inpatient hospital. Regional Blue Cross Blue Shield plan. Decided 2025.

61315

17×the plan's initial payment

Initially paid$2,226.94

IDR award$38,127

See the 22 line items behind these examples

Specialty	CPT	Service	Setting	Initially paid	IDR award	Increase
Vein & vascular	36475	Endovenous radiofrequency ablation, first vein	Ambulatory surgery center	$285.62	$62,699	220×
Interventional pain	64483	Transforaminal epidural injection, lumbar	Ambulatory surgery center	$179.04	$16,860	94×
Interventional pain	64484	Transforaminal epidural, each additional level	Ambulatory surgery center	$80.41	$12,736.50	158×
Interventional pain	64450	Peripheral nerve block	Ambulatory surgery center	$33.19	$24,768	746×
Spine surgery	63030	Laminotomy & discectomy, lumbar, one interspace	Outpatient hospital	$1,574.91	$77,000	49×
Spine surgery	63035	Each additional interspace	Outpatient hospital	$393.64	$44,000	112×
Vein & vascular	36475	Endovenous radiofrequency ablation, first vein	Ambulatory surgery center	$694.49	$46,000	66×
Spine surgery	22843	Posterior segmental instrumentation, 7–12 segments	Hospital emergency department	$989.69	$19,000	19×
Spine surgery	22853	Interbody biomechanical device	Hospital emergency department	$1,282.40	$85,000	66×
Spine surgery	63046	Laminectomy, thoracic	Hospital emergency department	$742.95	$37,000	50×
Spine surgery	63048	Laminectomy, each additional segment	Hospital emergency department	$519.22	$40,000	77×
Spine surgery	22610	Posterior arthrodesis, thoracic	Hospital emergency department	$774.66	$27,027	35×
Spine surgery	22614	Arthrodesis, each additional segment	Hospital emergency department	$1,906.08	$43,222.63	23×
Spine surgery	63085	Vertebral corpectomy, thoracic	Hospital emergency department	$2,320.05	$12,000	5.2×
Spine surgery	22327	Open treatment, thoracic vertebral fracture	Hospital emergency department	$911.91	$17,000	19×
Interventional spine	63056	Transpedicular decompression, lumbar	Ambulatory surgery center	$2,565.86	$73,000	28×
Interventional spine	63057	Decompression, each additional segment	Ambulatory surgery center	$541.26	$10,400	19×
Interventional spine	20553	Trigger point injections, 3+ muscles	Ambulatory surgery center	$30.53	$1,850	61×
Interventional pain	64772	Transection or avulsion of spinal nerve	Ambulatory surgery center	$1,643.68	$40,500	25×
Interventional pain	64635	Facet radiofrequency ablation, lumbar	Ambulatory surgery center	$719.88	$6,800	9.4×
Interventional pain	64636	Facet ablation, each additional level	Ambulatory surgery center	$364.07	$4,000	11×
Neurosurgery	61315	Craniectomy, evacuation of intracerebellar hematoma	Inpatient hospital	$2,226.94	$38,127	17×

Portfolio figures are Ascendix's own records for federal IDR disputes managed from January 2023 to the present. The examples are selected, de-identified determinations from that portfolio; patient, claim and practice identifiers are removed. An IDR award is the out-of-network rate set by a certified IDR entity; the plan then pays that amount less its initial payment and the patient's cost sharing. Past results do not guarantee future outcomes, and every dispute depends on its own facts and documentation.

Request an IDR eligibility review

What federal IDR is

A neutral decides the payment. You only get one shot at the offer.

Since January 2022, the No Surprises Act has limited what patients pay for certain out-of-network care. The difference between what the plan pays and what the service is worth is now settled between the provider and the plan.

When open negotiation fails, a certified IDR entity reviews both sides and selects one party's final offer. There is no splitting the difference, so the quality of the offer packet decides the outcome. The non-prevailing party pays the IDR entity's fee, and both parties pay a federal administrative fee.

Many disputes fail for procedural reasons: a missed business-day deadline, a claim that was never eligible, or a batch that should not have been batched. That is the work we take off your hands.

Which claims qualify

Three kinds of care fall under the federal process.

Emergency services

Out-of-network emergency care at a hospital emergency department or independent freestanding emergency department, including certain post-stabilization services.

OON providers at in-network facilities

Non-emergency services by out-of-network providers at in-network hospitals, hospital outpatient departments, critical access hospitals and ambulatory surgical centers. Think anesthesia, radiology, pathology, assistant surgeons, hospitalists and neonatology.

Air ambulance

Out-of-network air ambulance services billed to group health plans and health insurance issuers.

Usually federal IDR

Self-funded (ERISA) employer plans

Plans not regulated by state insurance law
Fully insured plans in states without a specified surprise-billing law for that service
Federal Employees Health Benefits plans

Usually the state process instead

Fully insured, state-regulated plans

When a specified state law sets the payment method for that service
Self-funded plans that have opted in to a state process where the state allows it
See the State arbitration page

Medicare, Medicaid and other government programs have their own payment rules and are not part of the federal IDR process. Uninsured and self-pay patients use a separate patient-provider dispute resolution process tied to Good Faith Estimates.

The timeline

Eight steps, each with its own clock.

Select a step to see what the rules require and what Ascendix does at that point. Timeframes reflect the federal rules as generally applied; the Departments update guidance and operations from time to time, and we work to the current version.

What Ascendix does

What we handle

From the first remittance to the final payment.

Eligibility screening

We review plan type, service, location, dates and any state law before anything is filed, so fees are not spent on disputes likely to be found ineligible.

Deadline control

Every dispute is tracked in business days from the remittance date. Open negotiation notices, initiations and offers go out inside the window.

Batching strategy

Where federal batching rules allow, similar items and services against the same plan move together, which can reduce cost per claim.

Offer packets

We assemble the supporting information the IDR entity may consider, with clear rationale for the amount you are asking for.

Negotiation

Many disputes settle in open negotiation. We negotiate on your behalf and bring every offer to you before accepting.

Award follow-through

Determinations are tracked to payment. Late or short payments get followed up, and results feed your A/R reporting.

What we will ask you for

Through a secure channel after onboarding, never through this website.

Claim and remittance data (835 or EOB) showing initial payment date and QPA
Itemized claim details: CPT/HCPCS, modifiers, units, place of service
Facility network status and service location
Provider credentials and specialty
Your usual charges and any prior contract history with the plan
Clinical complexity notes where relevant to the offer

When state law governs the plan, the dispute goes through the state.

Fully insured plans, no-fault auto carriers and workers' compensation insurers each have state-level processes for payment disputes. We identify the right forum, meet its deadlines and build the case.

Request a state arbitration review Federal or state?

State surprise-billing lawsPIP & no-faultWorkers' comp

Federal or state: which applies

The plan type decides the path, not the provider's preference.

Filing in the wrong forum gets a dispute dismissed. This is the first thing we check on every claim.

State process

Fully insured plans regulated by the state

The state has a surprise-billing law covering that service
The insurance card often shows the state regulator or "fully insured"
Some self-funded plans opt in where state law allows it

Federal process

Self-funded employer plans and gaps in state law

ERISA self-funded plans that have not opted in
Services or plans not covered by the state law
See Federal NSA IDR

State frameworks we navigate

Different states, different forums, different clocks.

New York

Independent dispute resolution under New York's surprise-billing and emergency services law (Financial Services Law, Article 6), using IDR entities designated by the Department of Financial Services. Covers emergency services and surprise bills under state-regulated plans, and certain bills to uninsured patients.

New Jersey

Binding arbitration under the Out-of-network Consumer Protection, Transparency, Cost Containment and Accountability Act (2018), overseen by the Department of Banking and Insurance. Applies to state-regulated plans and to self-funded plans that opt in.

Texas

Arbitration through the Texas Department of Insurance for out-of-network emergency care and certain services at in-network facilities under state-regulated plans, following the 2019 surprise-billing law.

California

Independent dispute resolution for non-emergency services by non-contracted providers at contracted facilities, under the state's 2016 surprise-billing law, through the applicable state regulator.

Other states

A growing number of states have their own surprise-billing payment standards or dispute processes. We check the rules for the state where care was provided and the plan type before choosing a path.

State laws, regulations and forum procedures change. Descriptions here are general summaries for orientation only. We confirm the current rules for each claim before filing.

PIP & no-fault arbitration

Auto-injury claims denied or cut? There is a state forum for that.

No-fault states give medical providers a route to challenge PIP denials and reductions. In New York, no-fault disputes are commonly handled through arbitration administered by the American Arbitration Association. In New Jersey, PIP disputes go through the state's designated dispute resolution organization.

Denials based on independent medical exams (IME) or peer reviews
Fee-schedule reductions and coding disputes
Late-payment and interest issues
Benefit exhaustion and coverage questions
Coordination with your attorney where representation is required

Workers' compensation disputes

Workplace-injury bills follow the state's fee schedule and its dispute rules.

Each state's workers' compensation board or division has its own process for medical bill disputes, authorization disputes and fee-schedule disagreements.

Bill objections and fee-schedule disputes
Authorization and medical necessity disputes
Required forms, reports and attachments
Carrier follow-up through the state process

How we run a case

Six steps, from intake to payment.

The same discipline we apply to federal IDR, adapted to the state forum's rules.

Intake and triage
We gather the claim, remittance, plan details and dates, and confirm which process (federal, state, no-fault or workers' compensation) applies.
Eligibility and deadline check
Each state sets its own filing windows and eligibility rules. We confirm the claim qualifies and calculate every deadline.
Pre-filing resolution
Where it makes sense, we try reconsideration, appeal or negotiation first. A paid claim is better than a won case.
Filing and submissions
We prepare the application, supporting documentation and position statement in the format the state forum requires.
Hearing or decision support
We respond to requests from the arbitrator or entity and coordinate with your counsel where a hearing or legal representation is needed.
Award follow-through
We track payment of any award, post it, and close the loop in your A/R reporting.

Pricing you can read in one sitting.

Four engagement models, no hidden extras. Your exact price depends on your specialty, volume and scope, and it is confirmed in a written agreement before any work begins.

Get your price Compare models

From 5–7% of collectionsConfirmed in writing

Engagement models

Pick how you want to work with us.

Most complete

Percentage of collections

5–7%

of monthly collections

We are paid when you are paid. Best for practices that want billing off their plate entirely.

Full end-to-end RCM
Coding, claims, denials and A/R
Payment posting and reconciliation
Patient statements
Monthly reporting and review call

Request pricing

Fixed rate

Custom

fixed monthly fee

A predictable fee for a scope of services we agree together.

Choose the services you need
Same fee every month
Scope reviewed as volume changes
Monthly reporting

Request a quote

Dedicated seat

Single

service specialist

One specialist for one function, working only on your account.

Billing, coding, A/R, denial or RCM specialist
Works your queues daily
Supervised by Ascendix leads
Weekly status updates

Talk to us

Remote in-house

Remote

RCM professional

A dedicated professional who works as part of your in-house team.

Works in your systems and processes
Your hours and priorities
Quality-checked by Ascendix
Scale up or down

Hire a specialist

Compare what's included

Side by side.

"If in scope" means you choose it when we agree your fixed-rate or dedicated-seat scope.

What you get	Percentage 5–7% of collections	Fixed rate Custom	Dedicated seat Single specialist	Remote in-house RCM professional
Medical coding & charge entry		If in scope	If in scope	If in scope
Claim scrubbing & submission		If in scope	If in scope	If in scope
Denial management & appeals		If in scope	If in scope	If in scope
A/R follow-up & underpayments		If in scope	If in scope	If in scope
Payment posting & reconciliation		If in scope	If in scope	If in scope
Eligibility & prior authorization		If in scope	If in scope	If in scope
Patient statements		If in scope	If in scope	If in scope
Works only on your account	–	–
Works inside your team's processes	–	–	Partly
Monthly reporting & review call			Weekly updates
Fee changes with collections		–	–	–

Project & dispute pricing

One-off work, quoted up front.

A/R clean-up projects

Old or inherited A/R worked as a defined project. Quoted on the size and age of the backlog, or as a percentage of what we recover.

Credentialing & enrollment

Quoted per provider and per payer, covering applications, CAQH, follow-up and confirmation of effective dates.

Federal IDR & state arbitration

Quoted per dispute or per batch after an eligibility review. Federal administrative fees and IDR entity fees are set by the government and the entities and are separate from our fee.

Revenue cycle assessment

Free. We review your setup, denials and A/R and tell you what we see, with no obligation.

PIP, MVA & workers' comp

Included in end-to-end RCM, or quoted separately when you only need auto-injury or workplace-injury billing.

Patient collections

Included in end-to-end RCM, or available on its own for practices with high self-pay balances.

What affects your price

Five things decide the number.

Tell us about these in the assessment form and we can quote quickly.

Specialty

Surgical and procedure-heavy specialties take more coding work per claim.

Claim volume

Higher volume usually lowers the effective rate.

Payer mix

PIP, workers' comp and out-of-network claims need more follow-up.

Services in scope

End-to-end or just the stages you need.

Existing A/R

A large old backlog may be handled as a separate project.

Refer a provider, earn 15% fee relief.

Know a practice, clinic or medical group that could use our help? Eligible referrals earn 15% fee relief. Eligibility and terms are confirmed in writing in your service agreement.

Refer a provider

Pricing questions

Before you ask.

Is the percentage on billed charges or collections?

On collections: the money that actually reaches your practice. If a claim is not paid, there is nothing to take a percentage of.

Can we start with one service and add more later?

Yes. Many practices start with denials or old A/R and move to end-to-end RCM once they see the results.

Are dispute fees included?

Our dispute work is quoted separately. Federal administrative fees and certified IDR entity fees are set outside Ascendix and are paid as the rules require.

When do we get a final price?

After the free assessment. The price, scope and responsibilities are all written into your service agreement before work begins.

Get a price for your practice.

Tell us your specialty, volume and current setup. We will come back with a clear proposal.

Get your price Call +1 (973) 544-3838

Five ways a practice gets paid. Five different rulebooks.

We bill and follow up across in-network, out-of-network, PIP and MVA, workers' compensation and patient self-pay, so nothing falls between the cracks when one patient touches more than one.

Request a free RCM assessment

In & out of networkPIP / MVAWorkers' compSelf-pay

In-network: commercial, Medicare & Medicaid

Contracted payers pay by contract and by rule. The money is lost in timely filing, missed authorizations and quiet underpayments.

Commercial PPO, HMO, EPO and POS plans
Medicare Part B and Medicare Advantage
Medicaid and managed Medicaid
Tricare and other government programs
Contract-rate checks on every payment
Timely-filing and appeal-deadline tracking
Audit and records-request support

Out-of-network

Out-of-network providers can earn more per claim, but only with the right billing, patient-balance rules and dispute strategy.

Out-of-network benefit verification
Claim submission with full itemization
No Surprises Act patient-protection compliance on balances
Open negotiation and single-case agreements
Federal NSA IDR and state arbitration
Underpayment tracking by plan and CPT

PIP / MVA / no-fault

Auto-injury care is paid by the auto carrier first, under state no-fault rules, with its own forms and cut-offs.

Claim setup: carrier, claim number, adjuster, date of loss
State no-fault forms and medical documentation
Fee-schedule billing and verification requests
IME and peer-review denial handling
Coordination with health insurance once PIP benefits are exhausted
Arbitration referral and support where applicable
Letters of protection and attorney liaison for MVA cases, as your policy allows

Workers' compensation

Workplace injuries are billed to the employer's carrier under the state's workers' compensation fee schedule.

Employer, carrier and WC case number capture
Authorization requests and tracking
State fee-schedule billing and required reports
Carrier follow-up and bill-objection response
Dispute support through the state board or division

Patient collections & self-pay

Patient balances are now a large share of revenue. Clear statements and kind follow-up get them paid without hurting the relationship.

Clear, branded patient statements
Payment reminders by mail, email or text (as you approve)
Payment plans to your policy
Self-pay estimates and Good Faith Estimates for uninsured patients
Patient billing questions answered by our team
Hand-off to your collection agency, if you use one

When one patient touches several payers

An auto accident can involve four of them.

PIP pays first, health insurance picks up after benefits run out, the patient owes a deductible, and an out-of-network surgeon may have a dispute right. We keep the order straight.

Primary: PIP / no-fault carrier
Billed under the state's no-fault rules until benefits are used or the claim is denied.
Secondary: the patient's health plan
Billed with the PIP exhaustion letter or denial, in-network or out-of-network.
Disputes, where eligible
No-fault arbitration for PIP denials, federal IDR or state arbitration for health-plan underpayments.
Patient balance
Only what the patient legally owes, explained clearly on the statement.

Billing across more than one payer type?

That is where most practices lose money. We will show you where.

Request a free RCM assessment Call +1 (973) 544-3838

30 specialties. From primary care to the operating room.

We work with small, large and multi-specialty practices: PCPs, nurse practitioners, surgeons and assistant surgeons, surgical centers, ambulatory surgery centers and emergency care centers. Each specialty has its own codes, modifiers, authorizations and denial patterns, and we build our workflow around yours.

Request a free RCM assessment

Primary careSurgicalBehavioralDiagnostic

Search specialties

Primary care & core medicine

Family Medicine

Patients of every age, so preventive, sick and procedure visits often land on one day.

Where we focusPreventive vs. problem E/M with modifier 25, vaccine administration, chronic care management

Primary care & core medicine

Internal Medicine

Adult primary care with complex, chronic conditions.

Where we focusE/M leveling by medical decision-making, TCM and CCM, Annual Wellness Visits

Primary care & core medicine

Pediatrics

Infants, children and adolescents, with heavy preventive volume.

Where we focusWell-child visits, VFC vaccine administration, developmental and behavioral screenings

Primary care & core medicine

Geriatric Medicine

Medicare-heavy panels with growing demand.

Where we focusAnnual Wellness Visits, advance care planning, CCM and Medicare Advantage risk documentation

Primary care & core medicine

Hospitalist Medicine

Inpatient and observation care for admitted patients.

Where we focusInitial, subsequent and discharge E/M, observation rules, split/shared visits

Surgical specialties

General Surgery

The foundational surgical discipline.

Where we focusGlobal periods, modifiers 58, 78 and 79, assistant-at-surgery billing

Surgical specialties

Orthopedic Surgery

Joint replacement, sports injury and spine.

Where we focusGlobal packages, DME, high PIP and workers' comp mix, implant billing

Surgical specialties

Neurosurgery

Complex brain, nerve and spinal procedures.

Where we focusMulti-level spine coding, prior auth, high-dollar out-of-network and IDR claims

Surgical specialties

Cardiothoracic Surgery

Heart and lung surgery for an ageing population.

Where we focusCo-surgeon modifier 62, high-value procedures, intra-operative services

Surgical specialties

Vascular Surgery

Arteries and veins, open and endovascular.

Where we focusEndovascular coding, supervision and interpretation, office-based lab billing

Surgical specialties

Plastic & Reconstructive Surgery

Elective aesthetics and post-trauma reconstruction.

Where we focusCosmetic vs. reconstructive medical necessity, prior auth, out-of-network billing

Surgical specialties

Otolaryngology (ENT)

Ear, nose and throat surgery and in-office procedures.

Where we focusEndoscopies, in-office procedures, allergy testing and immunotherapy

Surgical specialties

Urology

Urinary tract and male reproductive surgery.

Where we focusIn-office procedures, drug administration, imaging components

Surgical specialties

Ophthalmology

Cataract, retina and age-related eye care.

Where we focusCataract global periods, bilateral and eye modifiers, injectable drug J-codes

Surgical specialties

Colon & Rectal Surgery

Lower gastrointestinal surgery.

Where we focusScreening-to-diagnostic conversions, modifiers PT and 33, global periods

Surgical specialties