Re-Pricing Out of Network Claims

ProPeer clients report that 7% to 10% of all claims received are OUT OF NETWORK. No matter the size of your department, you cannot afford to pay out "out of network" rates.

ProPeer averages an approximate 70% hit rate on Out of Network claims.
ProPeer clients enjoy an average turn around time of 2 to 3 business days (in house) and average savings of approximately 18%* on Out of Network claims.
No changes are required in your current health plan or, for TPAs, no changes in your contracts with your insurers are required.
No start up fees are required to use this service. All fees are determined on a percent of savings, if there is no savings there is no fee to you.

NEGOTIATING OUT-OF-NETWORK CLAIMS

Claims are analyzed prior to negotiation for error, unbundling, proper CPT coding and appropriateness of services. A signed Agreement is obtained from the provider and forwarded to you for your records. Negotiated Out of Network claims are currently averaging 3 to 5 day (in house) turn around time with savings of approximately 13%*.

For more information about ProPeer’s out of network claims services, or other medical peer reviews services, please contact us.

* The savings listed above are only an average. ProPeer Resources cannot guarantee any savings on the claims submitted for Peer Reviews, Hospital Bill Audits, Re-Pricing or Negotiation.

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