Out-of-network claims negotiated case by case — single-case agreements before care, payer negotiations after adjudication, and No Surprises Act open negotiation and dispute resolution where they apply — so out-of-network care is paid at a defensible rate instead of written off.
Out-of-Network Negotiations
Turn out-of-network into revenue.
- Single-case agreement requests
- Post-adjudication rate negotiation
- No Surprises Act negotiation & IDR support
Stages 02 · 09 · 11 · 12 of 14
Specialists own every step. Automation handles the repetitive work. Nothing waits in a queue nobody is watching.
Identify & prepare
Out-of-network status is flagged at eligibility. Expected reimbursement, plan allowances, and the patient's cost-sharing position are documented before care wherever possible.
Negotiate the rate
Single-case agreements are requested before service. After adjudication, payer offers are negotiated against benchmark data and your fee schedule — never accepted at the payer's first number.
Escalate when it applies
For claims covered by the No Surprises Act, the 30-business-day open negotiation window is tracked and Independent Dispute Resolution is initiated with supporting documentation when the offer falls short.
Document & collect
Signed agreements are attached to the claim, payments are reconciled against the negotiated rate, and any remaining patient balance is billed only where your policy and balance-billing rules allow.
AI-assisted pattern detection and decision support that works alongside our billing professionals — never instead of them.
Out-of-network claims are flagged automatically at eligibility so negotiation starts before the visit, not after the payment.
Payer offers are compared against negotiation history and benchmark rates to prioritize the claims worth escalating.
Open-negotiation and dispute-filing deadlines are tracked and surfaced daily — specialists decide every offer and counteroffer.
Specialty-aligned specialists who know your payer rules.
If it's not here, an RCM specialist will answer it directly.
When a provider has no contract with a patient's plan, the allowed amount is not set by a fee schedule. Negotiating — before care through a single-case agreement, or after adjudication on the payer's offer — establishes a reimbursement rate for that claim instead of accepting the payer's default.
A structured review of denials, A/R aging, coding, and underpayments — findings are yours to keep, whether or not we work together.
- · Findings you keep, whether or not we work together
- · No patient information requested
- · A named RCM specialist, not a sales queue
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