PRP starts with the source claim file and organizes client-supplied documentation around the disputed item or service.

Begin with a complete claim record.

For a standard professional claim, PRP normally begins with the patient insurance card, provider EOB or remittance advice, CMS-1500, and operative notes. Practice and provider information—including a provider CV—is collected during startup, and unusual matters may require additional records.

Those materials should be uploaded through the separate secure application URL PRP provides after onboarding, never through a public form or ordinary scheduling field.

Connect evidence to a permitted circumstance.

CMS’s current Notice of Offer job aid identifies circumstances that may include provider training and experience, quality and outcome measures, market share, patient acuity or service complexity, facility teaching status and case mix, and good-faith network-contracting efforts.

The point is not to include every available document. It is to explain why a specific record matters to the offer for the disputed item or service.

Use a claim-specific structure.

  • Claim and dispute identifiers
  • Short service and payment summary
  • Offer and supporting rationale
  • Relevant provider or facility information
  • Relevant patient-acuity or service-complexity support
  • Source-document index and clear exhibit labels

Remove noise and avoid prohibited factors.

Duplicative records, unsupported generalizations, and data that cannot be tied to the disputed service can make a submission harder to review. CMS materials also identify prohibited factors that parties should not ask the certified IDR entity to consider.

Before filing, verify the current CMS offer form, guidance, and any case-specific request from the selected certified IDR entity.

Preserve the version that was submitted.

The operating record should show which source documents were received, which exhibits were included, when the package was finalized, and what was actually submitted. That version history supports later questions, outcome review, and payment follow-through.