CollectionPro, a national provider of out-of-network (OON) claims recovery and Independent Dispute Resolution (IDR) arbitration support, announced the release of a Free Evaluation to assess the eligibility of Out-of-Network Claims. This service is designed to help healthcare providers determine which OON claims may be eligible for recovery through federal and state arbitration processes.
The No Surprises Act (NSA), which took effect in 2022, significantly changed OON reimbursement workflows by prohibiting balance billing and shifting greater financial responsibility to payers. As providers face increased underpayments and complex administrative requirements, many struggle to determine which claims qualify for IDR escalation.
CollectionPro's new evaluation service offers a no-cost review of OON claims to help providers identify: claims potentially eligible for IDR under the No Surprises Act; claims that may qualify for arbitration under applicable state balance-billing laws; claims still within required filing and appeal windows; and claims that may be reopened, corrected or re-submitted for reconsideration. The evaluation provides a clear assessment of eligible out-of-network claims, giving providers a starting point for pursuing appropriate recovery.
"Many providers simply don't pursue arbitration because they aren't certain about which claims qualify," said Maverick Johnson, spokesperson for CollectionPro. "The Free Evaluation removes that uncertainty and helps providers identify whether a legitimate recovery pathway exists."
CollectionPro has supported more than 10,000 IDR filings under the No Surprises Act and reports a 92% success rate across multiple specialties, including emergency medicine, anesthesiology, radiology, pathology, dialysis, surgical subspecialties and air ambulance services. The company's team also reviews aging OON claims, including those up to 3 years old, to check their eligibility for reappeal and fresh arbitration.
CollectionPro typically offers full-fledged arbitration services to healthcare providers by advancing the entire administration and arbitration fees, leaving providers with no upfront risk. Providers pay a success-based fee, as low as 10%, only after reimbursement recovery.
The Free Evaluation is for a limited period applicable to all specialties burdened with OON claims, including but not limited to air ambulance, neurosurgery, anesthesiology, ambulatory surgical, orthopedics, plastic surgery, neonatology, emergency medicine, pathology, critical care providers, cardiology, nephrology (dialysis), radiology, obstetrics and gynecology (OB/GYN) and other providers managing OON claims with Medicare, Medicaid or commercial payers.
