Out-of-Network Billing Services
Out-of-network billing services that pursue fair payment on every OON claim while keeping your practice compliant with the No Surprises Act. Built for physicians, specialty groups, ambulatory surgery centers and facility-based providers who treat patients outside their contracted networks.
91% first-pass clean claim rate · 33% fewer AR days · HIPAA-compliant US-based team · No Surprises Act and IDR experience
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Why Out-of-Network Claims Lose Revenue
Out-of-network claims follow different rules from contracted claims, as our guide to how out-of-network billing works explains. Without a fee schedule to anchor payment, the first payment a plan issues is often well below the value of the service. Practices that accept that amount without review lose revenue on every encounter. Those that wish to challenge it must follow strict federal timelines.
The No Surprises Act protects patients from balance bills for emergency care and for many non-emergency services delivered by out-of-network clinicians at in-network facilities. In those cases the provider cannot bill the patient beyond in-network cost sharing. Payment disputes are settled through a 30-business-day open negotiation period, followed by the federal independent dispute resolution process when negotiation fails. A missed deadline usually forfeits the right to dispute. Self-pay patients must also receive a good faith estimate before scheduled care. Practices billing in states with their own surprise billing laws face a second set of rules. When billing teams lack the time to manage notices, consent forms, negotiation letters and IDR filings, underpaid claims remain unresolved without dedicated accounts receivable management services.
Out-of-Network Billing
How Our Out-of-Network Billing Services Work
MedLife MBS manages out-of-network claims from verification through final payment. Before the visit, our team confirms network status and out-of-network benefits. We identify whether the No Surprises Act applies and prepare the notice and consent documentation where the law permits it. After the plan issues its initial payment or denial, every OON claim is reviewed against benchmark data for the service and region. Underpaid claims enter open negotiation within the required window, with written offers supported by documentation of the complexity and acuity of the care provided. When negotiation does not produce a fair result, we prepare and file the independent dispute resolution submission, including batched items where the rules allow it. Each step is logged against the federal and state deadlines that apply. Our negotiators document the qualifying payment amount, the training and experience of the treating clinician and the complexity of the encounter, since these factors carry weight in negotiation and in IDR decisions. The services below can be delivered as a complete out-of-network program or added to an existing billing team.
- Network status and benefits verification: Our eligibility verification services confirm network status, out-of-network deductibles and coinsurance before care is delivered.
- No Surprises Act compliance: We identify protected services, prepare notice and consent forms where permitted and produce good faith estimates for uninsured and self-pay patients. Templates are reviewed whenever federal guidance changes.
- Payment review and open negotiation: Initial payments are compared with regional benchmarks. Underpaid claims receive written negotiation offers within the 30-business-day period.
- Independent dispute resolution filing: We prepare IDR submissions with supporting evidence, track every deadline and manage communication with the certified IDR entity.
- Appeals and denial management: Denied OON claims are corrected or appealed through our denial management services, with every outcome logged by payer.
- Patient balance billing: Allowable patient balances are billed clearly through our patient statement services, in line with federal and state protections.
17+ Years Experience
MedLife's Aim is to support our clients in reaching a state of financial stability and achieving excellence in their healthcare for their practices.
Our Process for Managing Out-of-Network Claims
Medlife knows that out-of-network billing can be complex. We possess the expertise and resources to ensure fair negotiation of your claims, which will in turn help your practices maximize collections while attaining financial stability.
Free Out-of-Network Claims Review
We review recent OON claims, payments and denials to estimate underpayment and identify claims still eligible for negotiation or dispute. The findings arrive as a written summary with estimated recovery by payer.
Payer and Benefit Mapping
Our team maps each payer's out-of-network policies and notes which plans fall under federal rules or state surprise billing laws.
Front-End Compliance Setup
We set up workflows for network checks, notice and consent forms and good faith estimates before scheduled care. Front-desk staff receive simple checklists for each step.
Claim Submission and Payment Review
Claims are submitted promptly. Each initial payment is reviewed against benchmark data within days of receipt.
Negotiation and IDR Management
Underpaid claims move to open negotiation and, where justified, to independent dispute resolution with all deadlines tracked.
Monthly Reporting
You receive a report on OON payments, negotiation outcomes, IDR results and open balances, followed by a review call with your account manager.
Out-of-Network Billing Results for Our Clients
Practices that move their out-of-network billing to MedLife MBS gain a documented record of every payment review, offer and dispute. Results are measured against the baseline set during the free claims review. Each monthly report shows payments recovered through negotiation and IDR, along with the claims still in progress. Leaders can see which payers underpay most often and how each dispute was resolved, which supports future network and contracting decisions.
Our Transparent Out-of-Network Billing Pricing
MedLife MBS prices out-of-network billing as a percentage of collections, which links our fee directly to the payments recovered. Practices that need negotiation and IDR support for a backlog of underpaid claims can choose a recovery-based fee for that work. The final rate depends on claim volume, specialty, payer mix and the share of claims that require dispute. Every proposal follows a review of your current OON data. You receive a written quote that explains the scope and how the fee is calculated before any agreement is signed. There is no obligation to continue after the initial review. Pricing is reviewed as your claim volume and payer mix change.
Maximized Reimbursements:
By negotiating on your behalf, our specialists will ensure that you get the highest possible pays for your out-of-network services.
Reduced Administrative Work:
We deal with all the complex billings allowing your workers to concentrate on giving quality health care to patients.
Regulatory Compliance:
MedLife adheres to current federal and state laws, reducing chances of compliance issues or audits.
Efficient Claim Management:
With the start-to-end management of claims, we actively work on denials and delays resulting in better cash flow for the practice.
Request a Free Out-of-Network Claims Review
Find out how much revenue your out-of-network claims are leaving with payers. Our team will review recent OON payments and denials, identify claims still eligible for negotiation or dispute and outline a recovery plan with clear priorities and timelines. The review carries no obligation. Complete the short form or call our team at (888) 668-7770 to schedule it.
Client's Feedback
MedLife has done a great job in simplifying our billing process. They take care of everything and give us the highest amount of money back. Their services made us happy. Their support has been vital in enhancing our financial results. Much Appreciated!
With MedLife, our billing processes become smooth. Their staff are professional and so we have seen a significant improvement in our cash flow. Thank you for your help and reliable follow-ups. You are Amazing.
MedLife provide high quality billing service. They keep us informed on every step and allow us to focus more on treating our patients. Their expertise has made a significant difference in our billing process. Highly recommended from my side.
We are satisfied with MedLife’s services. Our billing and finances got better because of their detailed work and continuous support. They offer excellent services! The hard work by their team has contributed significantly to the success of our practice.
Frequently Asked Questions About Out-of-Network Billing
Out-of-network billing is the process of submitting claims to a health plan when the provider does not hold a contract with that plan. Because payment is not set by a negotiated fee schedule, each claim requires review to confirm the plan paid a fair amount.
It depends on the service. The No Surprises Act prohibits balance billing for emergency care and for many non-emergency services from out-of-network clinicians at in-network facilities. For other services, balance billing may be allowed under state law and the patient’s plan terms.
The No Surprises Act is a federal law that has been in effect since January 1, 2022. It limits patient cost sharing to in-network amounts for protected services. It also creates a federal process for providers and plans to settle payment disputes.
Either party may begin open negotiation within 30 business days of receiving the initial payment or denial. The negotiation period then lasts 30 business days. If it ends without agreement, either party may initiate independent dispute resolution within 4 business days.
A good faith estimate is a written estimate of expected charges that providers must give uninsured and self-pay patients before scheduled care. If the final bill exceeds the estimate by $400 or more, the patient may use the federal patient-provider dispute process.
Yes. Several states have their own surprise billing laws for state-regulated plans. The federal law applies where a state law does not. Each claim must therefore be matched to the correct rules before any dispute is filed.
Most billing companies charge a percentage of collections for OON billing. Some offer recovery-based pricing for negotiation and IDR work. MedLife MBS provides a custom quote after reviewing your claims data.
Emergency physicians, anesthesiologists, radiologists, surgeons, ambulatory surgery centers and specialists with limited network participation see the greatest impact because a large share of their claims are paid without a contracted rate.
Out-of-Network Billing Resources
