BillingNav

What BillingNav does

BillingNav is a private legal services firm founded in 2011 and headquartered in College Park, Georgia (Atlanta metro), specializing in No Surprises Act (NSA) Independent Dispute Resolution (IDR) and balance billing defense exclusively for US health plans. The company manages the full IDR workflow — from case selection and brief development through submission to certified IDR entities — and reports a 66% client win rate over 2.5 years, compared to a ~12% industry average benchmark derived from CMS H1 2025 federal IDR supplemental data.

The offering is organized around four integrated service modules — NSA Disputes, Member Protection (balance billing defense), Cost Reduction (financial assistance navigation), and Contract Leverage (IDR-informed direct contracting strategy) — all supported by BillingNav Command™, a proprietary centralized case management platform that combines medical records, coding reviews, IDR submissions, and regulatory guidance in one workflow. Briefs are grounded in CMS public hospital pricing files, detailed coding analysis, and market benchmarking. The platform and the BillingNav Command™ trademark are registered brand identity assets.

BillingNav monetizes through professional services engagement on a consultation basis with no publicly disclosed pricing or long-term lock-in. Go-to-market is sales-led and direct: enterprise outreach to health plan C-suite executives, legal/compliance leadership, and claims teams, supplemented by content marketing (website, educational video, FAQs) and bottom-of-funnel phone/email consultation intake. The company is founder-owned and operated (Co-Founder & Chief Legal Officer Rick Hirsch), serves primarily Commercial & ASO Health Plans with secondary segments in self-funded/RBP plans and functional leadership, and currently operates with 1-10 employees serving the US Southeast from its Atlanta-area HQ.

Name

BillingNav

Legal name

BillingNav

Website

https://billingnav.com

Company type

Private

Founded year

2011

Operating status

Operating

Headcount range

1–10 employees

Short description

BillingNav is a private legal services firm that manages No Surprises Act Independent Dispute Resolution and balance billing defense exclusively for US health plans, reporting a 66% IDR win rate versus a ~12% industry average via its proprietary BillingNav Command™ platform and four integrated service modules.

Ownership category

akta.pro rank

Product category

Health Plan Legal Services

NAICS

Business Support Services (5614)

SIC

Services-Legal Services (8111)

akta.pro primary industry

Patient Billing, Statements & Payment Processing (HLACACAG)

akta.pro secondary industries

Charge Capture & Clinical Documentation Improvement (CDI) for Billing (HLACACAF), Healthcare Billing & Patient Payments Presentment (FSAMAJAH)

Keywords

• Health plan legal services
• Balance billing defense
• Independent dispute resolution
• No Surprises Act support
• Claims expense management

Headquarters

HQ city

Atlanta

HQ country

United States

HQ region

North America

Offices1 record

Markets served

GTM type

B2B

Offering type

Services

Cost components

Personnel, Technology or R&D, Operations, Marketing or Sales, Infrastructure

Revenue model

1. Legal Services - NSA IDR Support: End-to-end Independent Dispute Resolution strategy and advocacy services for health plans, including case selection, brief development, IDR submission, and certified entity coordination. Revenue derived from professional services engagement.

Go-to-market motion1 record

Distribution channels2 records

Marketing channels3 records

Core offering

BillingNav provides specialized legal services for health plans focused on No Surprises Act (NSA) Independent Dispute Resolution (IDR) and balance billing defense. The firm manages the entire IDR process from case selection through final determination, supported by its proprietary BillingNav Command™ case management platform, and offers four integrated service modules: NSA Disputes, Member Protection (balance billing defense), Cost Reduction (financial assistance navigation), and Contract Leverage (direct contracting strategy).

Product overview

BillingNav offers a platform-plus-modules architecture centered on NSA IDR dispute resolution and balance billing defense for health plans. The core offering consists of four integrated service modules — NSA Disputes, Member Protection, Cost Reduction, and Contract Leverage — all supported by the proprietary BillingNav Command™ case management platform. Each module can be engaged independently while sharing the centralized workflow infrastructure, enabling health plans to address IDR performance, balance billing exposure, financial assistance recovery, and provider contracting from a unified system.

Differentiator

Problem solved

Functional benefit

Products and services

• NSA Disputes (No Surprises Act Support) End-to-end IDR strategy managing the entire No Surprises Act Independent Dispute Resolution process from case selection through final determination, including certified IDR entity coordination and structured documentation. Targeted at health plans seeking to materially improve NSA IDR outcomes.
• Member Protection (Balance Billing Defense) Legal defense against inappropriate balance bills, evaluating disputed charges against applicable law, engaging providers directly, and protecting both members and plan financial exposure. Targeted at health plans managing out-of-network billing risk.
• Cost Reduction (Financial Assistance Navigation) Systematic identification and navigation of federal, state, manufacturer, and charitable financial assistance programs to lower member burden and reduce total plan spend. Targeted at health plans seeking to lower claims expense.
• Contract Leverage (Direct Contracting Strategy) IDR-informed provider contract negotiation using dispute outcomes and pricing intelligence to build fact-based negotiating positions backed by hospital pricing transparency data and market benchmarks. Targeted at health plans seeking stronger provider negotiations.
• BillingNav Command™ Centralized case management platform combining medical records, coding reviews, IDR submissions, and regulatory guidance in one integrated workflow for managing NSA disputes. Serves as the technology backbone supporting all of BillingNav's service modules.

Quantifiable outcome

• 66% NSA IDR win rate vs ~12% industry average — 5× better performance sustained over 2.5 years
• +1 more outcomes

Segments4 records

Ideal customer profiles4 records

Technology focussed Yes

API detail

Has API

No

API docs

API detail

Core technology

AI maturity

App detail

Feature3 records

Scale indicators3 records

Recent moves5 records

Expansion highlights3 records

Others

• Datavant: Datavant (formerly Ciox Health) specializes in healthcare data exchange and de-identification. While not a direct competitor, it sits in the same healthcare-data ecosystem BillingNav leverages for provider pricing and CMS public-file analysis.
• Definitive Healthcare: Definitive Healthcare provides market intelligence and data on the healthcare ecosystem. It is an enabling / ecosystem participant adjacent to BillingNav's hospital pricing intelligence and market benchmarking capabilities.

Broad incumbents

• Waystar: Waystar provides healthcare revenue cycle software to providers and payers, with broader scope than BillingNav but overlapping interest in claims payment, pricing transparency, and dispute documentation.
• Optum (Change Healthcare): Optum owns Change Healthcare and offers the largest revenue cycle and payment-integrity platform serving health plans, including technology-adjacent functions used in dispute workflows. Its broader portfolio includes overlapping capabilities to BillingNav's specialized IDR offering.
• Experian Health: Experian Health delivers identity, data, and revenue cycle solutions to payers and providers. While broader in scope, their payer-side solutions touch payment-integrity and provider-pricing data that parallels BillingNav's pricing intelligence layer.

Direct peers

• Zelis: Zelis provides cost-containment, payment integrity, and out-of-network solutions to health plans, directly overlapping with BillingNav's balance billing defense and IDR dispute offerings for commercial and ASO plans.
• MultiPlan: MultiPlan is a dominant cost-containment platform for health plans that includes out-of-network negotiation and IDR-adjacent services. They are the largest incumbent serving the same payer-side dispute-resolution value proposition as BillingNav.
• HealthScape Advisors: HealthScape is a consulting firm exclusively serving health plans and payers, including dispute and payment policy advisory. Their vertical alignment with plan-side strategy closely mirrors BillingNav's buyer base.
• Phia Group: Phia Group is a healthcare cost-containment firm specializing in balance billing, subrogation, and IDR-adjacent advocacy for payers, TPAs, and stop-loss carriers — closely comparable to BillingNav's focus on inappropriate balance bill defense.

Emerging players

• Health Catalyst: Health Catalyst offers analytics and decision-support to health plans and providers. Their analytics orientation overlaps thematically with BillingNav's data-advantage approach in tracking IDR outcomes and provider patterns.

Market position

Strengths5 records

Weaknesses5 records

Competitive moat4 records

Key risks6 records

Key highlights7 records

Customer concentration

• Xx.com/joinbillingnav
• LinkedInlinkedin.com/company/billingnav-llc

Revenue estimate

Valuation estimate

Number of profiles

Profiles1 record

Funding overview

Funding rounds

Investors

Funding detail is available on the Subscription and Enterprise plan.Contact sales →

M&A

Investments

M&A and investment is available on the Subscription and Enterprise plan.Contact sales →

Frequently asked questions about BillingNav