Federal IDR · No Surprises Act
Federal IDR disputes, from notice to drafted offer in seconds.
River Lake checks eligibility, drafts a QPA-based offer for every dispute, and recommends the IDR entity. Your team reviews and submits, and every federal deadline is tracked and flagged before it expires.
Is your health plan keeping up with rising IDR dispute volume?
Our platform pairs the judgment of an in-house subject matter expert with automation built for No Surprises Act deadlines. From intake to offer in seconds, not days.
One workflow, start to finish
AI-enabled No Surprises Act dispute tools that help health plans win more and pay less
Intake and eligibility
Every dispute screened on arrival, so ineligible cases are challenged instead of paid.
Merit files and offers
Defensible, QPA-based offers with the supporting file built alongside.
IDRE selection
Entity choices informed by real determination data, not guesswork.
Deadline tracking
Every federal clock watched for every case, so nothing is lost by default.
Loss-driver reporting
Determinations and payments tracked, and the reasons behind losses surfaced.
Built for health plans, self-funded insurers, and the third-party administrators (TPAs) that serve them.
The whole lifecycle, in one view
Every stage of an IDR dispute, from open negotiation to payment
- STAGE 1
Open negotiation
The 30-business-day window where many disputes can still be settled.
- STAGE 2
Offer submission
A defensible offer and supporting file, on time.
- STAGE 3
IDRE selection
Which certified entity hears the case, and when to object.
- STAGE 4
Determinations
Outcomes tracked so every decision informs the next case.
- STAGE 5
Payment
Awards settled inside the federal payment window.
Common questions
Federal IDR, answered
What is federal Independent Dispute Resolution (IDR)?
IDR is the process created by the No Surprises Act for resolving out-of-network payment disputes between health plans and providers. After open negotiation fails, a certified IDR entity (IDRE) reviews both parties' offers and selects one of them as the payment amount.
Who is River Lake Software built for?
Health plans, self-funded employers, and the third-party administrators (TPAs) that serve them. Anyone responsible for responding to federal IDR disputes on the payer side.
What does River Lake handle?
Intake and eligibility screening, merit files accuracys, QPA-based offer calculation, deadline tracking for every federal clock, IDRE selection informed by real determination data and payment, and loss-driver reporting.
Which IDR deadlines does the platform track?
Among others: 15 usiness days to submit an offer, 3 business days to object to the selected IDR entity. Missing any of them can lose a case before its merits are considered.
Dispute volume is up - Deadlines are tighter
Our platform combines subject-matter expertise with automation to take each IDR case from intake to offer in seconds, helping your plan reduce costs.
Our Approach
Automation your team can rely on
We work closely with each health plan client, bringing over 30 years regulatory and review expertise to the highly regulated IDR process. We bring automation and expert knowledge to help health plans control the cost and complexity of payment disputes.
Regulatory and review expertise
Judgment from people who have worked inside independent review, applied to the No Surprises Act rules and deadlines your plan faces.
Automations & analytics
Your dispute data, set beside CMS public records, so you can see where cases originate and what drives the outcome.
Built to be efficient & control cost
Clear next steps inside the workflow, so the insight turns into better submissions and fewer avoidable disputes.
From intake to offer in seconds, not days
Our platform pairs the judgment of an in-house subject matter expert with automation built for No Surprises Act deadlines. Each case moves from intake to a submitted offer with every federal clock tracked, so nothing is lost by default.
About River Lake Software
Practical tools for provider payment disputes
River Lake Software builds practical, AI-enabled tools that assist health plans with controlling the cost and complexity of provider payment disputes. Our first focus is the federal Independent Dispute Resolution (IDR) process under the No Surprises Act. Dispute volumes have far exceeded early projections, and payers lose the large majority of decisions, often on cases they could have won or never should have faced.
River Lake gives payer teams a clear view of the whole IDR lifecycle, from open negotiation, offer submission, IDRE selection through determinations, and payment. Plans can see where disputes originate, which factors drive losses, and where changes to process or documentation will cut both eligible dispute volume and total cost.
The platform does the repetitive work on every case: it checks eligibility, drafts the offer, and recommends the IDR entity. Your team keeps the final decision, with every federal deadline tracked and flagged before it expires.
We built River Lake from the inside. Our founders bring more than three decades of leadership in independent review, quality, and accreditation, paired with enterprise IT, cloud, and security operations. River Lake is built for health plans, self-funded insurers, and third-party administrators that serve them.
See your own IDR lifecycle clearly
We'll walk your team through the platform using the dispute patterns that matter to your plan.
About Our Founders
Built by people who have seen IDR from the inside
Independent review expertise on one side, enterprise cloud and operations discipline on the other.
Kimber Bishop, RN, BSN, LSSBB
Kimber is a healthcare quality and regulatory compliance executive with more than 27 years in healthcare and over 20 years of leadership in independent review, utilization management, quality improvement, and accreditation.
Most recently she served as an executive director of corporate quality performance at an accredited Independent Review Organization and CMS-certified federal IDR entity. There she led enterprise quality strategy across independent review, utilization management, and case management programs, and owned URAC accreditation, NCQA HEDIS measure certification, and CMS certification readiness. She designed an automated peer reviewer credentialing system, and her quality and clinical compliance operations scaled through triple-digit revenue growth.
Earlier in her career, Kimber led corporate quality management for a national behavioral health managed care organization, directing NCQA and URAC accreditation readiness across multiple health plans. She also served as a subject-matter expert in HEDIS and CMS risk adjustment, supporting Medicare Stars performance improvement initiatives. Her career began at the bedside as an emergency, trauma, and perioperative nurse, followed by years as a clinical review specialist and project leader at a state Quality Improvement Organization.
That path gives Kimber an unusual vantage point. She has seen independent dispute resolution from inside the entities that decide the cases. She knows what makes a submission defensible, where plans lose ground, and how regulatory detail turns into lost revenue. River Lake was built to put that insight in the hands of health plans.
Kimber holds a Bachelor of Science in Nursing and is a certified Lean Six Sigma Black Belt. She is centrally based in Missouri and partners with health plans across the United States.
Industry experience
- Independent review and federal IDRExecutive leadership in corporate quality performance, accreditation, and CMS certification
- Behavioral health managementCorporate quality management, NCQA and URAC readiness, HEDIS and Medicare Stars
- Healthcare quality improvementClinical review and project leadership for a state Quality Improvement Organization
- Acute clinical careEmergency, trauma, and perioperative nursing
Preston H. Balmain
Preston is an enterprise IT operations and cloud leader with more than 20 years running service delivery, hybrid cloud infrastructure, and cybersecurity programs across Fortune 500, federal, and regulated healthcare environments.
Today he leads global operations improvement for a government health services and healthcare technology organization. He runs Quality Assurance and Quality Control frameworks for Azure cloud operations and sustains contractual service availability above 99% across production Azure and AWS environments. He owns the IT operations governance framework and the accreditation and compliance repositories, works directly with external auditors during system validation audits, and is the primary link between customer and technical teams for Medicare software. His enterprise service desk transformation improved resolution time and first-contact resolution by 20%, cut ticket misrouting 30%, and raised customer satisfaction 10%.
Across his career, Preston has directed Zero Trust and identity and access management programs for federal enterprise customers, delivered cybersecurity services to more than 2,500 retail locations across the United States and Canada, and led global help desk and site reliability teams in IT distribution. He has defined ITSM governance for a U.S. military data center, managed large cloud and data center implementation programs in financial services technology, and led technology programs in tax services, retail, and professional services. His career began as a U.S. Air Force pilot, and he is a Gulf War veteran.
That background shapes how River Lake is built. A health plan's dispute platform has to be secure, available when a federal deadline is hours away, and ready for audit. Preston brings the operating discipline to deliver that: sound cloud architecture, governance, and service levels that hold as volume grows.
Preston holds a BBA in Production and Operations Management. He is ITIL 4 certified, a Six Sigma Green Belt, a Certified Scrum Master, and a Claude Certified Associate. He is based in Fort Myers, Florida.
Industry experience
- Healthcare technology and government health servicesGlobal operations improvement, cloud QA/QC, and audit and compliance governance
- Federal cybersecurityZero Trust and identity, credential, and access management programs
- Fortune 500 retailEnterprise cybersecurity program management across 2,500+ locations
- Global IT distributionGlobal help desk and site reliability operations
- DefenseITSM governance and continuous improvement for a military data center
- Financial services technologyCloud and data center implementation programs
- Military serviceU.S. Air Force pilot, Euro-NATO Joint Jet Pilot Training
Request a demo
Talk to us about your plan's IDR volume
Tell us a little about your plan and we'll set up a walkthrough of the platform.
Reach us directly
- Emailkimber@riverlake.ai
- Phone(656) 233-6677
What to expect
- A short conversationYour plan's dispute volume, deadlines and where cases are being lost.
- A walkthroughThe platform taking a case from intake to offer.
- Next stepsA plan for a pilot fitted to your team.
Trust & Security
Built to protect your plan’s data
IDR disputes carry claims and member information. River Lake is designed for HIPAA from the ground up: hosted on Amazon Web Services, encrypted end to end, and governed by agreements your compliance team will recognize.
River Lake is preparing for launch. This page shows how the platform is built and where each certification stands. We update it as each milestone is reached. Last updated October 2026.
At a glance
- By design
Hosting on AWS
Runs on Amazon Web Services in U.S. regions, using only AWS services eligible for HIPAA workloads.
- By design
Encryption
Data encrypted at rest with AES-256 keys managed in AWS Key Management Service, and in transit with TLS 1.2 or higher.
- Available
Business Associate Agreement
River Lake signs a BAA with every client before any protected health information is shared, and holds a BAA with AWS.
- In progress
SOC 2 Type I
Independent audit of our security controls, covering the Security and Confidentiality criteria.
- Planned
SOC 2 Type II
Independent audit confirming those controls operate effectively over time, following Type I.
- Before launch
Penetration testing
An independent firm tests the platform before launch and every year after. A summary letter is available on request.
How we protect your data
Security in every layer
Hosting and infrastructure
- Amazon Web Services, U.S. regions only
- HIPAA-eligible AWS services for anything that touches PHI
- Infrastructure defined as code, so every environment is built the same way
- Encrypted backups copied to a second AWS region, with tested restores
Data protection
- AES-256 encryption at rest; TLS 1.2+ in transit
- Each client’s data kept separate, with its own encryption key available
- Only the claim fields IDR requires are collected
- Data retained and deleted on a schedule agreed with each client
Access control
- Single sign-on with your identity provider (SAML or OIDC)
- Multi-factor authentication for every user
- Role-based permissions, so people see only what their job requires
- River Lake staff access is approved per task, time-limited and logged
Monitoring and audit trail
- Every view and change to a dispute is recorded in an audit trail
- AWS CloudTrail logs every administrative action
- Continuous threat detection and configuration checks (Amazon GuardDuty, AWS Security Hub, AWS Config)
- Alerts reviewed by a named security owner
Compliance program
- HIPAA business associate obligations met through signed BAAs
- Written security, access, incident response and vendor policies
- Annual HIPAA and security training for everyone with access
- Every vendor that touches data under a BAA or equivalent agreement
Incident response
- A documented plan to contain, investigate and resolve security events
- Client notification on the timelines set in each BAA
- Root-cause review and corrective action after every incident
Security in the cloud is shared. AWS secures the data centers, hardware and core services. River Lake is responsible for how the application is built, configured and operated on top of them, and for protecting your data within it.
Request our security documentation
Our SOC 2 report is shared with clients and prospective clients under a mutual nondisclosure agreement (NDA). Until the audit is complete, we share the following under the same terms:
- Security overview and architecture summary
- Completed security questionnaires (SIG Lite or CAIQ)
- Business Associate Agreement template
- Penetration test summary letter, once issued
Email us with your organization and the documents you need. We’ll send an NDA, and share the documents once it’s signed.
Request documentation → Or write to kimber@riverlake.ai with “Security documentation” in the subject line.Legal
Privacy Policy
Last updated September 29, 2026
River Lake Software ("River Lake," "we," "us") respects your privacy. This policy explains what we collect through this website and how we use it.
Information we collect
When you request a demo or contact us, we collect the details you provide: your name, title, organization, work email, mobile phone number (if given), your plan's approximate IDR dispute volume, and your message. We also collect basic technical information such as browser type and pages visited.
How we use it
- To respond to your request and schedule a demo
- To send the communications you have opted in to, including text messages
- To operate, secure, and improve our website and services
Text messaging (SMS)
If you opt in to text messages, we use your mobile number only to send the types of messages you agreed to. Message frequency varies. Message and data rates may apply. You can reply STOP at any time to opt out, or HELP for help.
No mobile information will be shared with third parties or affiliates for marketing or promotional purposes. Text messaging originator opt-in data and consent will not be shared with any third parties. Information may be shared with subcontractors that support our services, such as customer service or messaging providers, solely to deliver those services.
Sharing
We do not sell your personal information. We share it only with service providers who help us run our business under confidentiality obligations, or when required by law.
Protected health information
This website is not intended to collect protected health information (PHI). Please do not submit member or patient information through our forms. PHI processed through the River Lake platform is handled under a separate Business Associate Agreement.
Your choices
You may ask us to access, correct, or delete your information, or to stop contacting you, by emailing kimber@riverlake.ai or calling (656) 233-6677.
Contact
River Lake Software · kimber@riverlake.ai · (656) 233-6677
Legal
SMS Terms and Conditions
Last updated September 29, 2026
Program name and description
River Lake Software Notifications. When you opt in on our website, River Lake Software sends text messages about demo scheduling, appointment reminders, and account updates. If you separately opt in to marketing messages, we may also send product updates and promotional messages.
How to opt in
You opt in through the chat on our website, by providing your mobile number and agreeing to receive text messages from River Lake Software. This is the only place on our website where you can opt in to text messages. Consent is not a condition of purchase or of requesting a demo.
Opting out
You can cancel at any time. Text STOP to (656) 233-6677. We will send one message confirming that you have been unsubscribed, and you will receive no further messages. To join again, opt in the same way you did the first time.
Help
If you have trouble with the messaging program, reply HELP for assistance, or contact us at kimber@riverlake.ai or (656) 233-6677.
Message frequency and rates
Message frequency varies. Message and data rates may apply for any messages sent to you from us and to us from you. If you have questions about your text or data plan, contact your wireless provider.
Carrier liability
Carriers are not liable for delayed or undelivered messages.
Privacy
For privacy-related questions, see our Privacy Policy. No mobile information will be shared with third parties or affiliates for marketing or promotional purposes.