Maximize Revenue on
Out-of-Network Claims
Out-of-Network billing isn't just about submitting claims; it’s about aggressive negotiation. We fight for maximum allowable rates, manage complex appeals, and ensure compliance with the No Surprises Act to protect your practice's bottom line.
Aggressive Payer Negotiation
We don't accept initial underpayments. Our team strategically negotiates Usual, Customary, and Reasonable (UCR) rates to secure the highest possible payout.
Why OON Billing is Different
Out-of-Network billing lacks the structured fee schedules of in-network contracts. Payers frequently slash reimbursements or force claims into complex arbitration. We possess the specialized expertise to navigate this hostile terrain and win.
Single Case Agreements (SCA)
For specific complex cases, we preemptively negotiate Single Case Agreements with the payer to guarantee in-network-like reimbursement rates before the procedure.
No Surprises Act Compliance
We navigate the complexities of the federal No Surprises Act (NSA), managing Good Faith Estimates and the Independent Dispute Resolution (IDR) process.
Patient Financial Advocacy
We communicate clearly with patients regarding their OON benefits, co-insurance, and deductibles, preserving the doctor-patient relationship.
Securing Fair Compensation
Every Step of the Way
Our specialized OON revenue cycle process is designed to limit patient friction while forcing insurance companies to pay their fair share under state and federal regulations.
Deep Benefit Verification
We conduct exhaustive verifications to uncover hidden OON deductibles and out-of-pocket maximums, providing a clear financial picture upfront.
Strategic Claim Submission
Claims are submitted with precise documentation and coding strategies specifically tailored to trigger maximum allowable payouts from OON payers.
Aggressive Appeals & IDR
When payers inevitably underpay, we launch immediate, aggressive appeals based on UCR data and navigate the arbitration process if necessary.
Compliant Balance Billing
We handle patient balance billing strictly according to state and federal laws, ensuring maximum collection without violating surprise billing regulations.
Stop Accepting Initial
Underpayments
Your expertise deserves fair compensation. Partner with Valeria Healthcare Solutions to aggressively manage your Out-of-Network claims and boost your bottom line.