Collecting from Out-of-Network Billing Made Simple and Profitable
CollectionPro is here to maximize reimbursements, reverse denials, and help you take control of your out-of-network (OON) claims with expert billing and arbitration support. Today, providers and healthcare practices are facing more issues than ever while trying to get reimbursed for out-of-network services provided. An increasing number of OON claims are going denied or at best, severely underpaid. The losses are multiplying rapidly and accounts receivable continue to pile up fast.
For many physicians, providing out-of-network services or treatments is becoming a relentless struggle against delayed or denied payments from payers, low reimbursements due to tight payer negotiations, heavy administrative burden for appeals and disputes, and not to forget, confusing regulations of the No Surprises Act (NSA).
This is where OON claim experts like CollectionPro can make a real difference.
Get Paid 5x More from Out-of-Network Claims
Providing specialized billing support for out-of-network claims, we have dedicated experts who are adept at scrubbing such claims, building compelling arguments, resubmitting them, and then finally collecting the provider’s full dues from the payer. Having handled more than 10,000 IDR (Independent Dispute Resolution) cases with a 92% success rate, we bring unmatched experience and expertise in tackling the most complex challenges in out-of-network payments. Our in-house experts in the No Surprises Act are fluent in both the federal and state-level IDR processes.
Understanding payer strategies, using strategic NSA caveats, and building irrefutable arguments that preemptively counter payer denials, we’ve consistently achieved high recovery success in complex service categories. We further analyze each claim to determine if it qualifies for federal NSA, State IDR, or alternate legal recovery, so you get paid fast and to the max. In fact, our deep understanding of accounts receivable management lets us collect from underpaid and unpaid claims that are more than 365 days old or longer – often up to 5x the payer’s offer, or more!
Services We Offer
COMPREHENSIVE SOLUTIONS FOR OON CLAIMS RECOVERY, ARBITRATION, AND AR MANAGEMENT
- Identifying and Analyzing Denied/Underpaid Claims
- Re-appealing and Re-submitting Denied Claims
- IDR Filing Support & Documentation (under NSA)
- Advance Notice & Consent Forms
- Clinical Coding Support
- Negotiation on Behalf of Providers
- Audit, Automation & Reporting
proven process to maximize out-of-network reimbursements
Our 8-Step Path to Total Claim Recovery
ANALYSIS
We analyze all claims based on their age, value, CPT codes involved, Payer, and eligibility for IDR filing – using advanced analytics.
STRATEGY
Using historical data, past Payer behavior, and AI-assisted probability calculation, a fully customized recovery strategy is formulated.
REVIVAL
Eligible claims are reopened and fresh negotiations initiated, including securing a new extension of the arbitration window for re-appealing denials.
DOCUMENTATION
We gather all necessary documents and medical proof to build a compelling case, before scrubbing and resubmitting claims.
CODING
Every line item in the claim is scrutinized – batched or separated as necessary – and submitted to maximize reimbursement.
FILING
The refurbished claim is filed for fresh negotiation under federal Independent Dispute Resolution or state-specific arbitration laws.
RESOLUTION
We closely monitor and facilitate the process to ensure the best outcome for the Provider, supplying supporting data and evidence when required.
REMITTANCE
Every line item in the claim is scrutinized – batched or separated as necessary – and submitted to maximize reimbursement.
Who We Serve
Trusted by hospital-based and specialty care providers
- Emergency Medicine
- Physicians (ER Doctors)
- Trauma Surgeons / General Surgeons
- Cardiologists
- Neurologists
- Neurosurgeons
- Obstetrician-Gynecologists
- Chiropractors
- Physical Therapists
- Anesthesiologists
- Radiologists
- Pathologists (Laboratory Physicians)
- Neonatologists
- Hospitalists
- Intensivists (Critical Care Specialists)
- Assistant Surgeons
- Surgery Centers
- Orthopedic Surgeons
- Otolaryngologists (ENTs)
- Plastic and Reconstructive Surgeons
- Urologists
- Ophthalmologists
- Psychiatrists / Behavioral Health Specialists
- Vascular Surgeons
- Specialty Pharmacy
CollectionPro – The OON Billing Solution that Maximizes Your Revenue
All About the No Surprises Act for Out-of-Network Services
The No Surprises Act (NSA) of 2022 is still new for many. And for many it might be confusing, as with the passing of the act, billing for out-of-network claims and getting reimbursed from erstwhile ‘balance bills’ (which can no longer be sent to patients under the provisions of the Act) has changed significantly. At CollectionPro, we bring expert assistance in revenue cycle management (RCM) to help practices with problems related to OON claims. Streamlining operations, reducing administrative burdens, and preventing unnecessary delays that eat into revenue, our experts leverage proven strategies that effectively reverse denials and let providers collect their full dues from their OON claims.
Expert Healthcare Reimbursement through IDR
A cornerstone of the No Surprises Act is the Independent Dispute Resolution (IDR) system. IDR is an official arbitration process – supervised by CMS at the Federal level and other local agencies at the State level – that allows practices to bring their payer-reimbursement grievances stemming from out-of-network claims before a neutral, third party arbitrator. This is done in order to determine fair reimbursement from OON claims for healthcare professionals and organizations.
While impartial judgment is compulsory for practices struggling with low payer compensation, we have seen it can really be time-consuming and costly if handled in-house. This is where CollectionPro’s specialized IDR services take the driver’s seat, guiding you to success along the slippery roads of revenue recovery. From the initial case filing, analyzing Superbills and EOBs (Explanation of Benefits) and overseeing preliminary negotiations, through applying for IDR arbitrations and securing the win for you – our experienced team builds strong cases to help practices secure rightful payment. By outsourcing this complex step, you can not only protect your bottom line but further improve your overall RCM efficiency.
Payer Negotiation Services
Winning with OON billing isn’t just about compliance, you need experience. Our experience in working for both providers and payers gives us an added advantage that allows us to negotiate more favorable arrangements for your claim. We use the NSA knowledge and expertise of our in-house arbitration experts to help you receive a customized and sustainable solution. Combined with cutting-edge solutions and powerful strategies, our NSA acumen shines through every claim we work on. For practices navigating today’s competitive healthcare environment, effective payer negotiations can be the difference between survival and growth. With CollectionPro, you are always assured of reduced administrative roadblocks, faster resolutions, and improved reimbursement rates.
Balance Billing Prevention Solutions
There is no doubt that the No Surprises Act has transformed how patients perceive medical billing, especially in terms of paying anything in excess of the agreed copays and deductibles. In fact, surprise bills and exorbitant balance billing are no longer permitted under NSA. In view of this, we focus on working closely with payers to help surgeons, physicians and other paramedics get paid for all their out-of-network encounters, especially those made in an Emergency Room. By specializing in IDR and payer negotiations, CollectionPro effectively eliminates unnecessary patient disputes while ensuring your practice gets paid fairly by the payers directly.
WHY COLLECTIONPRO
Why Choose Us for OON Billing?
- We specialize in healthcare revenue recovery, with special focus on collecting from out-of-network claims eligible for IDR arbitration
- You can start using our services absolutely free as we advance all administration and arbitration fees on your behalf
- Our industry-lowest, contingency based fees of 10% of the balance (your claim value minus the payer’s offer, if any) are payable only if you win
- We have proven expertise in recovering revenue from highly aging and challenging claims, which are 365 days old and more
- Responsive support team available to address your concerns in your time zone
- Compliance-first approach that aligns with all Federal and State NSA requirements for zero-risk revenue recovery
- Transparent, real-time updates on your claim status and recovery progress
- Flexible partnership terms – with no binding contracts or hidden fees – that put your needs first
Stop losing revenue on out-of-network claims. Get the advantage of a billing partner who knows how to win against payer pushback. Let us simplify your OON claim management, minimize write-offs, shrink bad debt, and maximize your collections.
Whether you’re a solo physician, a small practice or a large group, we adapt to your needs.