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FAQ: CollectionPro's Partnership with RCM Company for Out-of-Network Claims Management
TL;DR
CollectionPro's partnership gives RCM companies a competitive edge by outsourcing complex out-of-network claim recovery with a 92% success rate and contingency-based pricing.
CollectionPro provides specialized expertise in No Surprises Act arbitration, handling claim analysis, documentation, and legal processes for out-of-network disputes through a structured partnership model.
This partnership helps healthcare providers receive fair reimbursement for out-of-network services, reducing financial burdens and ensuring patients face fewer surprise medical bills.
CollectionPro has contested 10,000 arbitration cases with a 92% success rate, turning complex healthcare billing disputes into recoverable revenue through specialized legal expertise.
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CollectionPro will serve as the dedicated Out-of-Network and No Surprises Act IDR arbitration arm for the billing organization, bringing specialized expertise to manage and resolve complex payer disputes and underpaid claims.
Healthcare reimbursement has grown increasingly complex with heightened regulatory ramifications and payer scrutiny, requiring niche legal, regulatory, and operational infrastructure that many full-service RCM companies lack for consistent success in this domain.
CollectionPro provides: 1) Out-of-Network claim recovery, 2) No Surprises Act-mandated IDR arbitration, and 3) Complex payer disputes across high-value specialties.
CollectionPro differentiates itself through: 1) Resident NSA and IDR experts with hands-on arbitration experience, 2) Strong performance metrics (10,000 cases contested, 92% success rate), 3) Turnkey dispute management from claim analysis to post-award recovery, and 4) Low, contingency-based pricing of just 10%.
RCM partners can offer OON and IDR services to provider clients without incurring fixed costs, hiring legal specialists, or assuming regulatory risk, while CollectionPro's contingency-based model aligns fees strictly with recovered revenue.
Since the No Surprises Act implementation in 2022, IDR case volume has surged beyond projections, creating mounting backlogs, rising arbitration fees, and increasingly technical payer arguments that require specialized expertise.
Johnson states that these are no longer extensions of routine accounts receivable but legal-regulatory processes requiring mastery of NSA rules, QPA benchmarks, documentation standards, and arbitration strategy.
Many full-service RCM companies, despite being strong in core billing, coding, and in-network claim follow-up, lack the specialized legal, regulatory, and operational infrastructure needed to consistently succeed in the out-of-network domain.
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