Pivotal Health Aims to Fix Provider Pay in Post-NSA World

NEW YORK, NY – January 20, 2026 – Radix Health, a technology firm that gained prominence for its dispute resolution software, announced today it has rebranded as Pivotal Health. The new name reflects a broader mission and explosive growth fueled by a healthcare industry grappling with the complex financial fallout of recent federal legislation.

The company’s evolution comes as healthcare providers report staggering revenue losses following the implementation of the No Surprises Act, a law designed to protect patients but one that has inadvertently squeezed provider finances. Pivotal Health is positioning itself as a crucial technology partner for hospitals and physician groups navigating this new, challenging reimbursement landscape.

“Our transition to Pivotal Health marks a defining moment in our evolution,” said Max Mangum, CEO and Co-Founder of Pivotal Health, in a statement. “Providers deserve a dependable technology partner who brings clarity, scale, and measurable results to the reimbursement process. This new brand reflects who we are at our core... using technology and AI to balance the scales of increasingly complex reimbursement for providers.”

The Unintended Squeeze of the No Surprises Act

When the No Surprises Act (NSA) took effect in 2022, its goal was to shield patients from crippling, unexpected medical bills from out-of-network providers. While largely successful on that front, it fundamentally altered the financial dynamics between healthcare providers and insurance payers, creating significant new pressures.

Industry-wide, providers have reported a nearly 40% decline in out-of-network reimbursements since the law's introduction. This revenue hit has been particularly acute for independent physician groups in specialties like emergency medicine, anesthesiology, and radiology, which often operate out-of-network. The legislation replaced direct negotiation and the ability to bill patients for remaining balances with a federal Independent Dispute Resolution (IDR) process to settle payment disagreements.

However, the system has been overwhelmed. Federal agencies initially projected about 22,000 IDR submissions for all of 2022. Instead, they received over 490,000 disputes between April 2022 and June 2023. This deluge has created a massive administrative bottleneck, with providers reporting long delays in getting disputes processed and receiving final payments. While physician groups have reportedly prevailed in 80-85% of these disputes, the cost and time required to fight each underpaid claim have become a significant burden.

“Pivotal Health is addressing one of the most urgent financial pressures facing healthcare providers of all sizes today: fighting for fair reimbursement,” noted Sofia Guerra, Partner at Bessemer Venture Partners. “Pivotal helps providers navigate these very intricate claims negotiations without the burden of administration and staff bloat.”

A Tech-Forward Response to a System Under Strain

Pivotal Health’s rapid ascent is a direct response to this market turmoil. The company, which saw a 15x increase in its client base in 2025, has moved to fill the gap with an AI-powered platform designed specifically to manage the complexities of the IDR process from start to finish.

The company’s solution integrates with major hospital Revenue Cycle Management (RCM) systems, automating the often-manual work of identifying underpaid claims, compiling necessary documentation, and managing the submission and appeals process. By leveraging artificial intelligence and a massive proprietary dataset, the platform aims to streamline workflows and improve outcomes for providers challenging low payments.

A key aspect of Pivotal’s strategy is its aligned-incentive business model. The company earns its revenue only after its provider clients have successfully been paid by the insurer. This success-based approach has made engaging in the IDR process more accessible and financially viable for providers who might otherwise lack the resources to contest every underpayment. This model effectively transforms the IDR process from a costly administrative headache into a significant source of recovered revenue.

This commitment to advanced technology is further evidenced by the company's focus on technical talent, actively recruiting senior machine learning engineers to continue building out the AI systems that power its platform.

A Strategic Evolution Beyond a Single Solution

The rebrand from Radix Health to Pivotal Health signifies more than just a name change; it represents a strategic evolution from a specialized IDR vendor to a comprehensive technology partner. The company is broadening its scope to address the entire reimbursement lifecycle, aiming to restore balance in payer-provider negotiations.

A cornerstone of this expansion is an aggressive partnership strategy. Pivotal Health has already forged alliances with over 20 major RCM providers and other provider service companies. By integrating its technology directly into the workflows of these established players, Pivotal gains immediate access to a vast network of hospitals and physician groups. These partnerships, including previously announced collaborations with Ventra Health and PayrHealth, create a holistic offering that combines contracting strategy with reimbursement recovery.

This ecosystem approach allows Pivotal to embed its technology deep within the healthcare financial infrastructure, making its tools a seamless part of the revenue cycle rather than a standalone, bolt-on product. The company’s stated mission is to provide transparency and simplicity in a system notorious for its opacity and complexity, positioning itself for long-term market leadership.

As the company continues to scale, its ability to deliver measurable financial results for providers will be the ultimate test of its expanded vision. With its new brand identity and a growing network of powerful partners, Pivotal Health is primed to play a significant role in helping providers maintain financial stability in an increasingly difficult operating environment.