Out-of-Network Negotiation
Out-of-network claim negotiation that protects your reimbursement
Out-of-network claims are often underpaid or stall in payer review. Our negotiators use usual-and-customary data, No Surprises Act processes, and payer relationships to secure fair payment.
What you get
Why practices hand out-of-network negotiation to us
Higher OON payments
Negotiations backed by benchmark data instead of accepting the payer's first offer.
Single-case agreements
Agreements secured before care starts, for patients who need out-of-network services.
Regulatory know-how
Open negotiation and Independent Dispute Resolution handled correctly and on time.
Less staff time
We manage the back-and-forth so your team doesn't have to.
How it works
Our process, step by step
- Step 1
Claim review
OON claims and payer offers are reviewed against benchmark rates.
- Step 2
Negotiate
We counter with documented usual-and-customary data.
- Step 3
Escalate
Open negotiation and IDR are initiated when offers remain unfair.
- Step 4
Settle & post
Agreements are documented and payments posted and reconciled.
Questions
Common questions about out-of-network negotiation
Behavioral health, surgical, emergency, lab, and specialty providers who see a significant share of out-of-network patients.
Usually as a percentage of the additional amount recovered above the payer's initial offer, so you only pay when we improve the outcome.
Find out what your billing is really costing you
Send us 90 days of claims data and we'll show you where revenue is slipping through, how much is recoverable, and what we would fix first. It's free and there's no obligation.
We sign a BAA before any patient data changes hands.
