Out-of-network RCM · Federal IDR
Your out-of-network claims are worth more than the first payment.
Evident reviews every out-of-network payment, negotiates what was underpaid, and takes claims to IDR when payers won’t move. It starts with The Underpayment Report: send 3–5 out-of-network EOBs and get back a claim-by-claim report — what each claim paid, what the same code actually wins in IDR in your state, and the dollar gap between them. Free, in 3 business days. You keep your current biller.
Get your Underpayment ReportIDR Data
The record is public.
Every federal IDR determination is published by CMS. We built our negotiation practice on that record — 2023 Q1 through 2025 Q4, determined line items only — and it now lives here, as the evidence behind every number we put in front of a payer.
| Specialty / market | Provider win rate | Median selected offer |
|---|---|---|
| Orthopaedics | 87.4% | 22.82× QPA |
| Intraoperative neuromonitoring | 87.5% | 18.62× QPA |
| Surgical assistants | 89.5% | 30.76× QPA |
| Radiology | 93.3% | 4.98× QPA |
| Anesthesia | 84.2% | 3.29× QPA |
| Texas — all specialties | 85.2% | 4.93× QPA |
Source: IDR Data (idrdata.org), from CMS Federal IDR public use files, 2023 Q1–2025 Q4. Benchmarks show what arbitrators have selected nationally; they are not a guarantee for any individual claim.
Explore the full dataset — every specialty, state, payer and CPT code — at IDRData.org →
Why Evident
Most IDR firms ask you to take their word for it.
A private database you’ll never see.
Every number we quote comes from the full federal record — 8.2 million determined line items, published openly at IDR Data for anyone to check.
Sign first. See your numbers later.
We price your claims before you sign anything: send 3–5 EOBs and get a claim-by-claim Recovery Map in 3 business days. Free, and yours to keep either way.
Run by executives. Or by software.
Evident is founded and led by a practicing orthopaedic surgeon — and we’re paid only on what we recover: a percentage of the additional recovery, nothing else.
of resolved IDR cases come from five large, mostly PE-backed groups.
The system works — the wins are just concentrated where the dedicated IDR teams are. Independent practices win at similar rates when they file. Most never do, because eligibility, batching, deadlines, and arbitration prep are a second job. That second job is Evident.
The problem
Why claims stay underpaid
Underpayment is rarely an error. It is the default outcome of a process designed so the payer’s first number stands unless someone with data, time, and standing challenges it.
The posted payment
The payer’s initial payment becomes the final number unless it is challenged with evidence. A generic appeal rarely moves it. A specific number, benchmarked against the federal IDR record, does.
The deadline
Open negotiation runs on a 30-business-day window, and IDR eligibility expires with it. While A/R ages on a spreadsheet, the window to act closes — quietly, claim by claim.
The biller gap
Your biller’s job is submitting clean claims and posting payments. Working an underpayment — negotiation, filings, arbitration prep, determination tracking — is a different discipline. In most practices, nobody owns it.
Process
How recovery works
No switch, no rip-and-replace, no upfront fee. Four steps — and the report is free.
Send
Send 3–5 higher-dollar OON EOBs by secure link, BAA signed first. That is all we need to run your numbers.
Get your Underpayment Report in 3 business days
Claim by claim: what was paid, what the same code actually wins in IDR in your state, what is recoverable, and the recommended route. Yours to keep either way.
Negotiate, then arbitrate
We open negotiation inside the 30-day window with a specific, evidence-backed number — not a template appeal. If the payer won’t move, we file federal or state IDR: eligibility, batching, filings, and arbitration prep, with every deadline tracked.
Recover
We follow determinations through to payment. Our fee is a percentage of the additional recovery only — if we recover nothing, you owe nothing.
The offer
The Underpayment Report
Not a sales call — a report, built from your claims and the federal record. Send 3–5 out-of-network EOBs; in 3 business days you have the answer, claim by claim, in dollars. Four parts:
Free. Yours to keep, whether you hire us or not.
The Recovery Map
Every claim you send, priced three ways: what was paid, its fair value from CMS outcomes for that CPT, state, and payer, and the estimated recoverable — with the recommended route: negotiate, file IDR, or don’t pursue.
The Deadline Check
Which of your claims are still inside their negotiation and IDR windows — and which expire when. Claims age out every month; the report tells you what is still alive before it goes quiet.
The 2026 Re-Screen
Claims that were too small to file at the old $115 federal admin fee, re-checked at the new $15 fee — and at 50-line batching from November 1, 2026. Last year’s write-offs, priced again.
The Payer Pattern
How each of your payers actually behaves in IDR, from 8.2M determined line items: who settles in negotiation, and who only pays after arbitration — so the route on every claim is chosen on evidence, not habit.
“If a claim isn’t worth pursuing, the report says so. We’re paid on recovery, not on advice.”
Proof
A real report, anonymized
This is the analysis that starts most engagements: a provider’s own paid claims, run against the federal record before any contract is signed. Practice name and dates of service removed.
Texas surgical-assist claims
A Texas surgical-assist provider shared a month of paid claims. We matched 10 of the 27 to their CPT codes in the CMS public use files — and priced what those same visits would have won in arbitration.
The distance between those two numbers is the report — and it was visible before the provider spent a dollar.
The Texas record, across every determined dispute
That gap is not one practice’s luck. Across every determined Texas dispute in the CMS public use files, the provider’s offer wins the large majority of the time — at a median of nearly five times the plan’s own qualifying payment amount.
New in 2026
The filing math changed.
Two federal rule changes take effect in 2026, and both cut the cost of disputing a claim. Claims that were too small to file last year — the ones practices write off without a second look — may be worth filing now. The 2026 Re-Screen in your Underpayment Report is how you find out which of yours qualify.
Services
What we do
Most clients start with out-of-network recovery layered onto their current billing. Nothing else has to change.
Out-of-network billing & recovery
Keep your current biller. We review every OON payment, benchmark it, and negotiate underpayments with a specific number — handled end to end, with no change to your existing workflow.
Federal IDR services
When negotiation stalls, we take it to arbitration — federal and state IDR — and own eligibility, QPA review, filings, batching, arbitration prep, and determination follow-up, so deadlines never slip.
Anesthesia billing
Anesthesia is not generic billing. We work the details other billers miss — base and time units, AA / QK / QX / QY / QZ modifiers, and medical direction for concurrent CRNA cases.
Full-cycle RCM
For practices that want one accountable partner: coding, claims, denials, posting, and A/R across commercial, Medicare, and Medicare Advantage.
Who we serve
Practices that bill OON at in-network facilities
If your cases happen in-network but your group is out-of-network, underpayment is structural — not occasional.
Every specialty, with its IDR record →
For billing companies
We partner with billing companies that want OON negotiation and IDR handled for their clients — behind the scenes, without building an IDR desk in-house.
Anupam Pradhan, MD
Practicing orthopaedic surgeon · Founder, Evident RCM
The founder
Built by a physician. Run by RCM experts.
“I started Evident because payers were paying a fraction of what our work was worth — I saw it on my own remittances, in my own practice — and most independent practices had no practical way to fight back.”
Evident was founded by a practicing orthopaedic surgeon who runs an independent out-of-network practice. That is the difference between Evident and a generic billing vendor: the claims are reviewed by people who know what the work was worth, because they have stood on both sides of the payment. Behind the practice sits a specialist RCM team with 20+ years across negotiation, IDR filings, and full-cycle operations — working IDR under the No Surprises Act since it took effect in 2022.
Trust & compliance
Handled properly, by design
Recovery work touches PHI, payer contracts, and federal deadlines. The safeguards are not fine print — they are the operating rules.
BAA before anything moves
A business associate agreement is signed on request before you send a single document. Nothing is reviewed without one in place.
Secure transfer only
EOBs move through a secure upload link — never as ordinary email attachments, never through consumer file tools.
Patients held harmless
Patients are never balance-billed. Under the No Surprises Act, the dispute is between your practice and the payer, start to finish.
Contingency, in writing
Our fee is a percentage of the additional recovery only. If we recover nothing beyond what you were already paid, you owe nothing.
Questions
Before you send the EOBs
The Underpayment Report
See what your claims were actually worth.
Send 3–5 higher-dollar out-of-network EOBs. In 3 business days you get The Underpayment Report: what each claim paid, what the same code actually wins in IDR in your state, and the dollar gap between them. Free — yours to keep, whether you hire us or not.
The service
Out-of-network recovery, owned end to end.
Evident layers onto your existing billing — you keep your biller, your systems, your workflow. We review every out-of-network payment, negotiate what was underpaid with payer-data-backed numbers, and take claims to IDR when payers won’t move. Paid on contingency: a percentage of the additional recovery only.
The mechanism
How OON underpayment actually happens
It is not a billing error, and it is not random. It is built into how the payer’s first number is calculated.
The QPA anchor
Under the No Surprises Act, the payer’s opening position is anchored to the qualifying payment amount — the QPA, the plan’s median in-network rate for the same service in the same area. Your payment starts from their median contracted rate, not from the value of the work, and stays there unless it is challenged. The QPA is a starting anchor, not a finding of value — arbitrators select provider offers well above it every day.
The unexamined remittance
Most practices post OON payments and move on — there is no step in a normal billing workflow where someone asks “was that the right number?” against an external benchmark. Underpayment compounds quietly, claim after claim, month after month.
The expiring window
Challenging a payment runs on a clock: a 30-business-day open-negotiation window, then a short IDR initiation window after it closes. Miss the sequence and the claim is finished at the payer’s number — no appeal reopens it.
What we review
Every OON payment. Not a sample.
Sampling finds the underpayments you already suspect. Reviewing everything finds the ones you don’t. Every out-of-network payment that posts gets checked, claim by claim:
Benchmark check
Each payment is compared against actual federal IDR outcomes for that CPT, state, and payer — what arbitrators have selected for the same work, not a fee schedule guess.
QPA review
The payer’s qualifying payment amount is examined for the errors that drag it down — wrong service area, stale contracted rates, codes grouped that should not be.
Route decision
Each underpaid claim gets a route: open negotiation, federal IDR, state IDR, or don’t pursue — chosen on the payer’s actual behavior in the record, with the filing deadline attached.
Deadline ownership
Every window is tracked from the date of the initial payment. Nothing expires silently on a spreadsheet.
How it runs
Negotiate with a number. Arbitrate when they won’t move.
Two stages, one owner. Most recoveries settle in the first; the second is what makes the first work.
Open negotiation
Inside the 30-business-day window, we put a specific number in front of the payer — benchmarked against the federal IDR record for that code, state, and payer. Not a template appeal asking for “reconsideration”: a priced claim, with the evidence behind it and arbitration as the stated alternative.
IDR
If the payer won’t move, we file — federal or state IDR, whichever governs the plan. Eligibility, batching, offer preparation, and determination follow-up are handled end to end. How federal IDR works →
“Patients are never balance-billed. The dispute is between your practice and the payer — start to finish.”
Proof
A real report, anonymized
The same analysis that starts most engagements — a provider’s own paid claims, run against the federal record before any contract is signed. Practice name and dates of service removed.
Texas surgical-assist claims
A Texas surgical-assist provider shared a month of paid claims. We matched 10 of the 27 to their CPT codes in the CMS public use files — and priced what those same visits would have won in arbitration.
The Texas record, across every determined dispute
That gap is not one practice’s luck. Across every determined Texas dispute in the CMS public use files, the provider’s offer wins the large majority of the time — at a median of nearly five times the plan’s own qualifying payment amount.
Also
Also: full-cycle RCM
Some practices would rather have one accountable vendor than a biller plus a recovery layer. For them, Evident also runs full-cycle revenue management: coding, claims submission, denial management, payment posting, and A/R follow-up across commercial, Medicare, and Medicare Advantage — with the same OON review and IDR discipline built in rather than bolted on. It is an option, not the pitch: most clients start with recovery only and keep the biller they have.
For billing companies
We run OON & IDR for your clients, under your umbrella
Billing companies partner with Evident to offer negotiation and IDR without building an IDR desk in-house. Your clients keep their relationship with you; we do the eligibility, negotiation, filings, and determination tracking behind the scenes, and report through you. Your clients get the recovery capability of a dedicated IDR team — you get to offer it without hiring one.
The Underpayment Report
Find out what your OON claims were actually worth.
Send 3–5 higher-dollar out-of-network EOBs. In 3 business days you get the report: what each claim paid, what the same code wins in IDR in your state, and the gap. Free — yours to keep, whether you hire us or not.
Federal IDR
The No Surprises Act gave you a remedy. This is how it works.
Independent dispute resolution is the federal process for settling out-of-network payment disputes. It rewards the side that shows up with evidence — and the evidence is public: providers’ offers are selected in 84.9% of federal determinations. Evident runs the whole process: eligibility, negotiation, filings, offers, and determination follow-up.
Eligibility
Federal or state? It depends on the plan.
Not every dispute goes to the federal process. Which door you use is determined before anything is filed — and filing in the wrong one costs the claim its window.
The federal IDR process covers most disputes involving self-funded (ERISA) plans, and plans in states without their own qualifying process. It is administered through the federal portal, with certified IDR entities deciding between the two offers.
Some states run their own dispute process for state-regulated, fully insured plans. Where a state process applies, it governs — its own eligibility rules, timelines, and decision-makers.
Texas is a state-process state for state-regulated plans: mediation and arbitration run through the Texas Department of Insurance (TDI). But a large share of Texas coverage is self-funded — and those disputes go through the federal process. Sorting a Texas practice’s claims between TDI and federal IDR, claim by claim and plan by plan, is part of every engagement we run.
The timeline
Four stages, all of them on a clock
The process is sequenced, and the sequence is unforgiving. Each stage’s window opens only when the previous one closes.
The payer issues its initial payment (or denial). The date of that payment starts every clock that follows — which is why every OON payment has to be reviewed when it posts, not at quarter-end.
A 30-business-day window to negotiate directly with the plan. Either side can open it; if it closes without agreement, the dispute becomes eligible for IDR. Our negotiations open with a specific, data-backed number — many claims settle here.
IDR must be initiated within a short window — 4 business days after the negotiation period ends. The parties select a certified IDR entity, submit their offers and supporting evidence, and pay the administrative fee.
The IDR entity selects one of the two offers — there is no splitting the difference — and the payer must pay accordingly. We track the determination through to actual payment.
What wins
The offer closest to the evidence wins
IDR is sometimes called “baseball arbitration”: the arbitrator picks one offer, whole. That structure rewards the offer that is demonstrably grounded — and punishes round numbers and billed-charge anchoring alike.
Winning offers are built from what arbitrators have actually selected for the same CPT code, in the same state, against the same payer — drawn from the CMS public use files. Our offers are priced from that record, code by code.
Arbitrators must consider the QPA, and they weigh the additional statutory factors — provider training and experience, case complexity, patient acuity, market share, prior contracted rates. An offer that engages those factors with specifics beats one that simply demands more.
Related line items can be batched into a single dispute — same payer, same service type, same negotiation period — which spreads the fixed cost of filing across many claims. Batching is what makes smaller claims economically filable at all, and it is where the 2026 changes bite (below).
New in 2026
The filing math changed — in your favor.
Two federal rule changes take effect in 2026, and both cut the cost of disputing a claim. Claims that did not clear the old economics — too small to file, written off without a second look — deserve a re-screen at the new numbers. The 2026 Re-Screen in your Underpayment Report does exactly that.
IDR Data
What the federal record shows
Every number we negotiate with comes from IDR Data — our analysis of the CMS Federal IDR public use files, 2023 Q1 through 2025 Q4, determined line items only.
Explore the full dataset — every specialty, state, payer and CPT code — at IDRData.org →
Benchmarks show what arbitrators have selected nationally; they are not a guarantee for any individual claim.
The Underpayment Report
Which of your claims are worth filing?
The Underpayment Report answers it claim by claim — including the Deadline Check, which shows which of your negotiation and IDR windows are still open. Free, in 3 business days.
Anesthesia
Anesthesia billing is not generic billing.
Anesthesia is paid on a formula — base units, time units, and modifiers — that most general billers were never trained to work, and that the QPA system discounts hardest. Evident’s anesthesia practice handles the unit math, the medical-direction rules, and the IDR filings that follow from both.
Source: IDR Data (idrdata.org), from CMS Federal IDR public use files, 2023 Q1–2025 Q4. Benchmarks are not a guarantee for any individual claim.
The unit math
Base units + time units — and every unit is money
No other specialty is paid this way. An anesthesia charge is built, not looked up, and small errors in the build are small permanent discounts on every case.
Base units
Each anesthesia code carries a base unit value reflecting the work of the procedure itself — the pre-anesthetic evaluation, induction, and the typical monitoring the case requires. The wrong code, or a missed qualifying circumstance, starts the claim below its value before time is even counted.
Time units
On top of base units, anesthesia is paid for time — from the start of preparation through handoff, converted to units. Start and stop times, concurrency overlaps, and documentation gaps all change the unit count. Time is where anesthesia claims quietly lose value: imprecise time capture is an underpayment that repeats on every single case.
The conversion factor
Units are multiplied by a conversion factor to become dollars — and anesthesia’s factors and rate structures differ from the rest of the fee schedule. A biller working from general RCM habits will misprice anesthesia without ever seeing an error message.
Modifiers
Five modifiers decide what the case pays
The modifier states who did the work and under what arrangement — and the payment follows it. Getting them right is documentation, scheduling, and billing working as one system.
Personally performed
The anesthesiologist personally performed the case, start to finish. Full payment — and the documentation has to show a single-provider case.
Medical direction, 2–4 cases
The anesthesiologist medically directs two to four concurrent cases involving qualified individuals. Payment splits between the directing physician and the CRNA — the split has to be billed correctly on both sides.
CRNA, medically directed
The CRNA’s side of a medically directed case. Paired with the physician’s QK or QY claim — mismatched pairs are a denial and audit risk.
Medical direction, one case
The anesthesiologist medically directs a single CRNA case. One-to-one direction pays differently from multi-case direction; the claim has to say which it was.
CRNA without direction
The CRNA practices without medical direction by an anesthesiologist. Billed on its own — and frequently the arrangement payers misprice most.
Direction vs. supervision
Medical direction is a standard, not a label
Whether an anesthesiologist “directed” a case is defined by specific required steps — performing the pre-anesthetic exam, prescribing the plan, participating in the most demanding portions including induction and emergence, monitoring the course, and remaining physically available. Cases run beyond the concurrent-case limit, or without the required steps documented, are medical supervision, not direction — and they pay at a different, lower structure.
Why it matters on the claim
Billing direction rates for supervision-level involvement is a compliance exposure; billing supervision for cases that were truly directed is a voluntary discount. The concurrency count, the timestamps, and the attestation have to agree — we review them together, because payers and arbitrators do.
Why QPA math hits anesthesia hardest
The QPA is a median of contracted rates — and contracted anesthesia rates were set in a market where a few large groups accepted deep discounts for exclusivity. The median therefore bakes in those discounts as if they were the value of the work. A unit-based specialty, priced off a compressed median, gets underpaid by formula — which is exactly the kind of systematic gap IDR exists to correct, and why anesthesia wins there at 84.2%.
The Underpayment Report — Anesthesia
See what your cases were actually worth.
Send 3–5 higher-dollar out-of-network anesthesia EOBs. The report prices each claim against what the same codes actually win in IDR in your state. Free, in 3 business days — yours to keep either way.
Specialties
Where out-of-network underpayment concentrates.
Evident serves practices that bill out-of-network at in-network facilities — the specialties where the facility is contracted, the group providing the service is not, and the payer’s QPA math does the rest. Where federal IDR outcomes exist, we show them; the record is the pitch.
Orthopaedic surgeons operate at in-network hospitals and surgery centers while their groups stay out-of-network — trauma call, fracture care, and joint replacement included. Implant-heavy, high-dollar claims are exactly where a QPA-anchored payment diverges most from what arbitrators award: at a 22.82× median selected offer, orthopaedics has one of the widest gaps in the entire federal record. Evident was founded by a practicing orthopaedic surgeon; this is home ground.
Anesthesia groups cover in-network facilities around the clock while remaining out-of-network themselves — and get paid on a base-plus-time-unit formula the QPA compresses hardest. Unit math, medical direction, and modifiers AA / QK / QX / QY / QZ decide every dollar. Our anesthesia practice, in depth →
Neuromonitoring is ordered by the surgeon, required by the case, and delivered by a group the patient never chose — the classic No Surprises Act fact pattern. IONM claims are chronically underpaid relative to their IDR outcomes, with a median selected offer of 18.62× QPA.
Assistant surgeons and surgical first assistants post the widest gap in the federal record: a 30.76× median selected offer against QPA. Payers pay assist claims at fractions of a percent of what arbitrators award for the same visits — our anonymized Texas proof on the OON Recovery page ($1,527 paid against a ≈$63,244 median award) is from exactly this specialty.
Hospital-based radiology is read where the patient presents, not where the group is contracted. Radiology posts the highest provider win rate of any major specialty in the federal record — 93.3% — because the underpayment pattern is so consistent that arbitrators correct it nearly every time it is challenged.
Emergency physicians staff in-network emergency departments while their groups remain out-of-network, and patients have no choice of either. EM claims are OON by structure, not by anyone’s decision — and they run through the same review, negotiation, and IDR discipline as every specialty above.
Independent labs and ancillary providers process volume at small per-claim dollars — the profile the old $115 filing fee made unrecoverable. At the 2026 fee of $15 and 50-line batching, volume claims are exactly what the new math reopens. The 2026 Re-Screen in the Underpayment Report is built for this book of business.
ASCs host the cases while the professional groups around them bill out-of-network — and facility-side OON exposure follows the same pattern: in-network setting, out-of-network claim, QPA-anchored payment. We review professional and facility-adjacent OON claims together, so the whole case is priced as one picture.
All figures: IDR Data (idrdata.org), from CMS Federal IDR public use files, 2023 Q1–2025 Q4, determined line items only. Benchmarks show what arbitrators have selected nationally; they are not a guarantee for any individual claim.
The Underpayment Report
Your specialty’s record is public. Your claims are the question.
Send 3–5 higher-dollar out-of-network EOBs and get your claims priced against your specialty’s actual IDR outcomes in your state. Free, in 3 business days.
Anupam Pradhan, MD
Practicing orthopaedic surgeon · Founder, Evident RCM
About Evident
Built by a physician who got tired of the remittances.
“I started Evident because payers were paying a fraction of what our work was worth — I saw it on my own remittances, in my own practice — and most independent practices had no practical way to fight back.”
Anupam Pradhan, MD is a practicing orthopaedic surgeon — hip and knee replacement — who runs an independent out-of-network practice. He founded Evident RCM after watching the same pattern repeat in his own A/R: careful work, posted payments at a fraction of its value, and no realistic mechanism for a practice his size to push back. The No Surprises Act created the mechanism. What independent practices lacked was a team built to run it.
That team is Evident: specialists with 20+ years across revenue cycle operations — negotiation, IDR filings, deadlines, and determinations — working federal IDR since it took effect in 2022. The practice is physician-led and deliberately narrow: out-of-network review, negotiation, and IDR, done claim by claim, priced off the public federal record we publish at IDRData.org.
The Underpayment Report
See what your claims were actually worth.
Send 3–5 higher-dollar out-of-network EOBs. In 3 business days you get the report: what each claim paid, what the same code wins in IDR in your state, and the dollar gap between them. Free — yours to keep, whether you hire us or not.
The Underpayment Report
A report, not a sales call.
Send 3–5 out-of-network EOBs; in 3 business days you get back the answer, claim by claim, in dollars — what each claim paid, what the same code actually wins in IDR in your state, and the gap still recoverable. Free. Yours to keep, whether you hire us or not.
What’s in it
Four parts, one document
The Recovery Map
Every claim you send, priced three ways: what was paid, its fair value from CMS outcomes for that CPT, state, and payer, and the estimated recoverable — with the recommended route: negotiate, file IDR, or don’t pursue.
The Deadline Check
Which of your claims are still inside their negotiation and IDR windows — and which expire when. Claims age out every month; the report tells you what is still alive before it goes quiet.
The 2026 Re-Screen
Claims that were too small to file at the old $115 federal admin fee, re-checked at the new $15 fee — and at 50-line batching from November 1, 2026. Last year’s write-offs, priced again.
The Payer Pattern
How each of your payers actually behaves in IDR, from 8.2M determined line items: who settles in negotiation, and who only pays after arbitration — so the route on every claim is chosen on evidence, not habit.
“If a claim isn’t worth pursuing, the report says so. We’re paid on recovery, not on advice.”
How it works
Three steps. No PHI in this form.
Tell us about the practice
The short form below — practice, specialty, volume, and the payer that concerns you most. No claims documents, no patient information.
BAA, then a secure link
We send a business associate agreement for signature, then a secure upload link. Your 3–5 EOBs travel only through that link — never through this form or ordinary email.
Your report in 3 business days
The Underpayment Report lands in your inbox. If the numbers say pursue, we work on contingency — a percentage of the additional recovery only. If they say don’t, the report was still free.
Request received
Your report is in motion.
Thank you — your request is in. Here is what happens next:
Anything urgent in the meantime: hello@evidentrcm.com · (214) 556-1250
Questions first?
Talk it through instead.
If you’d rather understand the numbers before sending anything, call or email — a practicing surgeon’s team answers, not a call center.
Legal
Privacy Policy
Scope of this policy
This Privacy Policy describes how Evident RCM (“Evident,” “we,” “our,” or “us”) collects, uses, discloses, and protects information when you visit our website, contact us, or engage our revenue-cycle services.
It applies to information we handle in our role as a business partner to healthcare providers. It does not govern information handled directly by payers, clearinghouses, or your own practice management system.
Information we collect
We collect two categories of information:
Information you provide directly. When you request a claims review, contact us, or enter into a service agreement, we collect your name, practice name, email, phone number, role, and the details you share about your claim volume and specialty.
Information we receive to perform services. Once engaged, we receive claim-level data from you or your systems to perform negotiation and IDR work. This may include protected health information (PHI) as defined under HIPAA. PHI is handled under a Business Associate Agreement (BAA) and our HIPAA Notice of Privacy Practices.
We also collect limited, standard technical information when you visit our website — IP address, browser type, pages visited, and referring URL — primarily for security and to improve the site.
How we use information
We use the information we collect to:
- Respond to your inquiry and deliver the services you’ve requested
- Prepare, submit, and support negotiation and IDR filings on your behalf
- Communicate with you about your account, results, and relevant updates
- Improve our services, security, and website performance
- Comply with legal, regulatory, and contractual obligations
We do not sell your information, and we do not use PHI for marketing purposes.
How we share information
We share information only as necessary to deliver our services or meet our legal obligations:
- Service providers. Cloud hosting, document storage, and analytics providers that are bound by confidentiality and, where applicable, Business Associate Agreements.
- Payers and IDR entities. Information required to negotiate payment or file an IDR case on your behalf.
- Legal authorities. When required by law, subpoena, or to protect our rights.
We do not share your information for third-party marketing.
Security
We maintain administrative, technical, and physical safeguards designed to protect information against unauthorized access, use, alteration, or disclosure. Access to PHI and sensitive business data is limited to personnel who need it to perform their role.
No system is perfectly secure. If we identify a breach affecting your information, we will notify you consistent with applicable law and contractual requirements.
Your choices and rights
You may request to access, correct, or delete information you have provided to us by emailing hello@evidentrcm.com. Some information must be retained to meet legal or contractual obligations.
Patients whose PHI is processed by Evident should contact the treating provider; we act only at the provider’s direction under a BAA.
Changes to this policy
We may update this policy to reflect changes in our practices or legal requirements. The “last updated” date at the top of this page reflects the most recent revision. Material changes will be communicated to active clients as required by contract.
Legal
Terms of Service
Agreement to these terms
These Terms of Service (“Terms”) govern your access to and use of the Evident RCM website and any related services described on this site. By using the site or contacting Evident to request services, you agree to these Terms.
If you engage Evident to deliver revenue-cycle services, a separate Services Agreement will govern that relationship and will control in the event of any conflict with these Terms.
Our services
Evident RCM provides revenue cycle management services, specializing in out-of-network claims — including payer negotiation, Independent Dispute Resolution (IDR) filings under the No Surprises Act, full-cycle billing, and related analytics and reporting.
We are not a law firm, and we do not provide legal advice. Our services are operational and analytical. Providers are responsible for their own legal and compliance decisions.
Outcomes on individual claims vary based on payer behavior, case facts, and evidence. Historical win rates and recovery estimates described on this site do not guarantee a specific outcome on any specific claim.
Acceptable use of the website
You agree not to use the site to:
- Violate any law, regulation, or third-party right
- Attempt to gain unauthorized access to any system or account
- Interfere with the operation or security of the site
- Scrape, crawl, or extract content except through publicly documented means
- Transmit malware, spam, or other harmful content
Intellectual property
The Evident RCM name, logo, site content, and software are owned by Evident or its licensors and are protected by copyright, trademark, and other laws. You may view and share site content for personal, non-commercial purposes with proper attribution. Any other use requires written permission.
Client accounts and data
If you engage Evident as a client, you are responsible for the accuracy of the information and claim data you provide. You represent that you have the right to share that data with us for the purpose of our services, including any applicable patient authorizations or Business Associate Agreements.
We handle PHI under HIPAA and the terms of an executed BAA with you. See our HIPAA Notice for more.
Disclaimers
The website and its content are provided “as is” and “as available.” To the fullest extent permitted by law, Evident disclaims all warranties, express or implied, including merchantability, fitness for a particular purpose, and non-infringement.
Nothing on this site constitutes legal, tax, accounting, or medical advice. You should consult appropriate professionals before making decisions based on information presented here.
Limitation of liability
To the fullest extent permitted by law, Evident and its officers, employees, and contractors will not be liable for any indirect, incidental, special, consequential, or punitive damages arising from your use of the site. Our total liability for any claim arising from your use of the site is limited to one hundred U.S. dollars ($100).
Liability in connection with our services is governed solely by the Services Agreement you sign with Evident.
Governing law
These Terms are governed by the laws of the State of Texas, without regard to conflict-of-laws principles. Any dispute arising from these Terms or your use of the site will be resolved exclusively in the state or federal courts located in Dallas County, Texas, and you consent to their jurisdiction.
Changes to these terms
We may update these Terms to reflect changes to the site, our services, or the law. The “last updated” date at the top of this page reflects the most recent revision. Continued use of the site after a change constitutes acceptance of the updated Terms.
Contact
Questions about these Terms? Email hello@evidentrcm.com or call (214) 556-1250.
Legal
HIPAA Notice
Last updated · April 22, 2026
Our role as a Business Associate
Evident RCM operates as a “Business Associate” as defined by the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”) and the HITECH Act, when providing revenue-cycle services to healthcare providers (“Covered Entities”).
In that role, we handle Protected Health Information (PHI) only as permitted under a signed Business Associate Agreement (BAA) with the provider.
What PHI we handle
To perform negotiation and Independent Dispute Resolution work, we receive claim-level information that may include:
- Patient names, dates of birth, and demographic identifiers
- Procedure and diagnosis codes
- Dates and locations of service
- Charge and payment information
- Insurance information and Explanation of Benefits data
We do not receive direct clinical records unless specifically required to support a case and authorized by the provider.
Permitted uses of PHI
We use PHI only to perform the specific services described in our BAA and Services Agreement with the provider, including:
- Reviewing claims for recovery opportunity
- Preparing negotiation correspondence with payers
- Preparing and filing IDR cases
- Producing reports and analytics for the provider
We do not use or disclose PHI for marketing, and we do not sell PHI under any circumstances.
Safeguards
We maintain administrative, physical, and technical safeguards that comply with the HIPAA Security Rule, including:
- Role-based access controls and least-privilege policies
- Encryption of PHI in transit and at rest
- Workforce HIPAA training and confidentiality agreements
- Audit logging and regular security review
- Incident response procedures and breach notification protocols
Subcontractors
When we engage subcontractors who will receive or access PHI, we require them to sign agreements that impose the same restrictions and safeguards required of us as a Business Associate. We maintain a current list of such subcontractors and provide it to our clients on request.
Breach notification
If we discover a breach of unsecured PHI, we will notify the affected Covered Entity without unreasonable delay and in any case within the timeframe required by our BAA and applicable law. Our notice will include the information required under HIPAA so the Covered Entity can fulfill its own notification obligations.
Individual rights
Individual rights regarding PHI — including access, amendment, accounting of disclosures, and restrictions — are administered by the Covered Entity (the provider who treated the patient). If you are a patient seeking to exercise these rights, please contact the provider directly.
Evident will support the Covered Entity in meeting these obligations as required under our BAA.
HIPAA contact
Questions about our HIPAA practices can be directed to our Privacy Officer at hello@evidentrcm.com. For complaints, you may also contact the U.S. Department of Health and Human Services Office for Civil Rights.
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