Out-of-network billing done right under the No Surprises Act
We bill out-of-network claims correctly, follow No Surprises Act rules, negotiate with payers and use the federal independent dispute resolution process when it makes sense.
What’s included
- Out-of-network claim submission
- Patient cost-sharing rules under the No Surprises Act
- Good-faith estimates for uninsured and self-pay patients
- Open negotiation with payers
- Independent dispute resolution (IDR) support
- Single case agreement requests
How we handle it
Review
Check whether the No Surprises Act applies to the service.
Bill
Submit with correct notices and patient cost-sharing.
Negotiate
Open negotiation on low payments.
Escalate
Federal IDR or a single case agreement where it fits.
Details that matter
The No Surprises Act protects patients from surprise bills for emergency care and for certain non-emergency care from out-of-network providers at in-network facilities. In those cases, patients pay in-network cost-sharing, and payment disputes between provider and payer go through a 30-day open negotiation and then, if needed, federal independent dispute resolution.
Questions about out-of-network billing
Can we balance bill patients out of network?
For services covered by the No Surprises Act, generally no. For other services it depends on state law and patient consent. We review each case.
See where your revenue is going.
Send a few details and we will set up a short call to review your claims, denials and A/R. No cost and no commitment.
We sign a Business Associate Agreement before we handle any patient data.