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OON Reimbursement Service

Maximize Your Out of Network
 Reimbursements Reimbursements Reimbursements

RMBServ negotiates directly with insurance payers on your behalf to secure the highest possible reimbursement for out-of-network services turning underpaid claims into full, fair payment.
Get Free Consultation
650-240-0061
HIPAA Certified
US-Based Team
Performance-Based
Fast Resolution
Direct Payer Negotiation
85% Higher Reimbursement

85%

Avg Increase in OON Reimbursement
↑ Above initial payer offer

30d

Avg Negotiation Resolution Time
↓ Fast turnaround

99%

Claim Acceptance Rate
↑ Industry leading

27+

Specialties Covered
✓ All major specialties

What We Handle For You

  • Direct Payer Negotiation
Included
  • Fair Market Value Analysis
Included
  • Claim Documentation & Appeals
Included
  • NSA / IDR Process Filing
Available
  • Underpayment Recovery
Included

About This Service

What is Out-of-Network Out-of-Network Out-of-Network
Negotiation?

Out-of-network (OON) negotiation is the process of engaging directly with insurance payers to secure fair and higher reimbursement for services rendered to patients whose insurance plan does not include your practice in its network.
Contracting is the negotiation and execution of fee schedules and agreements with payers to ensure you receive fair reimbursement rates for the services you provide.
With the No Surprises Act (NSA) and Independent Dispute Resolution (IDR) process now in effect, providers have more legal tools than ever to challenge unfair OON reimbursements. However, navigating these processes requires deep expertise a single procedural error can disqualify your claim entirely.
RMBServ handles every aspect of OON negotiation from initial claim documentation and fair market value benchmarking to direct payer negotiation and formal IDR filing when necessary ensuring your practice receives every dollar it has earned.

85%

Average increase in reimbursement above initial payer offer

3x

Typical recovery increase vs accepting payer's first OON offer

30d

Average resolution time for OON negotiations handled by RMBServ

27+

Specialties covered from surgery and anesthesia to mental health

Direct Payer Negotiation

We contact insurance payers directly and negotiate on your behalf using market rate data, clinical documentation, and a proven strategy to maximize what they pay for your OON services.
  • Fair market value benchmarking by specialty and region
  • Preparation of negotiation package with clinical evidence
  • Direct communication with payer representatives
  • Multi-round negotiation until best rate is secured
  • Written settlement documentation and confirmation

No Surprises Act & IDR Filing

When payers refuse to negotiate fairly, we escalate through formal legal channels filing under the No Surprises Act’s Independent Dispute Resolution process to enforce your right to fair payment.
  • NSA eligibility determination for each claim
  • IDR initiation and certified arbitration filing
  • Arbitration package preparation and submission
  • Offer strategy aligned with Qualifying Payment Amounts
  • Full process management through final determination

Core Services Included

Market Rate Analysis

We benchmark your charges against regional and national fair market rates to build the strongest possible negotiation case with data payers cannot easily dispute.

Claim Documentation

Complete preparation of all supporting clinical notes, operative reports, and billing records required to justify higher reimbursement to the payer.

Direct Payer Negotiation

Our specialists engage payer representatives directly using proven strategies to consistently secure reimbursement well above the initial offer.

IDR Process Filing

When negotiation stalls, we file through the federal Independent Dispute Resolution process a powerful legal tool to enforce fair OON payment.

Underpayment Recovery

We identify all underpaid OON claims and pursue recovery including historical underpayments that may go back several months or billing cycles.

Step by Step

Our OON Negotiation OON Negotiation OON Negotiation Process

From claim review to final payment a proven, step-by-step approach that consistently secures significantly higher reimbursements for out-of-network providers.
Step 1

Claim Review & Eligibility Assessment

We begin by reviewing your outstanding OON claims to assess negotiation eligibility. We determine which claims fall under the No Surprises Act, which are best suited for direct negotiation, and which require IDR building a clear strategy for each one from the start.
NSA Eligibility Check Claim Triage Strategy Planning

Step 2

Fair Market Value Benchmarking

We analyze regional and national reimbursement data for each procedure code and specialty to establish a credible fair market value. This benchmarking forms the foundation of our negotiation argument giving us data payers cannot easily dismiss.
Regional Benchmarks Medicare Rates Specialty Data

Step 3

Negotiation Package Preparation

We compile a complete, professional negotiation package including clinical documentation, operative reports, medical necessity evidence, and benchmark comparisons a compelling, data backed case that maximizes payer willingness to settle fairly.
Clinical Documentation Medical Necessity Benchmark Comparison

Step 4

Direct Payer Negotiation

Our specialists initiate direct contact with the insurance payer's provider relations and reimbursement team. We present our case, counter low offers with data, and negotiate through multiple rounds until we reach the highest achievable settlement for your claims.
Provider Relations Contact Multi-Round Negotiation Settlement Strategy

Step 5

IDR Filing (When Needed)

If direct negotiation does not yield a fair result, we escalate by filing through the federal Independent Dispute Resolution process under the No Surprises Act. We manage the entire IDR from initiating the dispute to preparing our arbitration submission with a well supported offer amount.
IDR Initiation Arbitration Package QPA Analysis

Step 6

Settlement Confirmation & Payment Posting

Once a settlement is reached whether through direct negotiation or IDR we obtain written confirmation from the payer, ensure the agreed payment is received, and post it accurately to your billing system. We also monitor for underpayment against the agreed settlement and follow up immediately if the payer pays less than agreed.
Written Settlement Payment Verification Accurate Posting

Fast Resolution

Average 30-day resolution significantly faster than unmanaged OON claims

85% Higher Avg Payout

We consistently secure reimbursements well above the payer's initial OON offer

NSA & IDR Experts

Full expertise in No Surprises Act compliance and IDR process filing

HIPAA Compliant

All claim data and negotiations handled with full HIPAA compliance always

Why Choose RMBServ

OON Negotiation That Gets
 Real Results Real Results Real Results

Most practices accept the payer’s first OON offer leaving thousands of dollars on the table. RMBServ fights for every dollar, using data, expertise, and legal tools to dramatically increase what you receive.
Top Reason

Don't Accept the First Offer. It's Never the Best One

Insurance payers routinely underpay OON claims, knowing most providers will accept whatever they offer. RMBServ changes that dynamic. Our specialists negotiate aggressively using market data and clinical evidence and when necessary, we take it to federal arbitration under the No Surprises Act.
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Avg Increase

0 d

Avg Resolution

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Specialties

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States Served

85% Higher Avg Payout

We consistently negotiate reimbursements 85% above the payer's initial OON offer turning underpaid claims into significant recovered revenue for your practice.

NSA & IDR Expertise

We are fully versed in No Surprises Act rules and Independent Dispute Resolution filing giving you access to powerful federal legal tools that most providers never use.

Data-Driven Negotiation

Every negotiation is backed by regional market rate benchmarks, Medicare reference rates, and specialty specific data building an airtight case payers cannot easily reject.

30-Day Avg Resolution

Our proactive approach resolves most OON negotiations within 30 days dramatically faster than the months long delays practices experience when handling OON claims on their own.

Performance Based Pricing

We work on a performance-based model at our flat 3.99% rate meaning you only pay when we successfully recover your OON revenue. If we don't collect, you owe nothing.

HIPAA Secure & Confidential

All patient records, claim data, and negotiation communications are handled with strict HIPAA compliance your data and your patients' privacy are always protected.

Get Started Today

Stop Accepting Low OON Offers
 Let Us Negotiate Let Us Negotiate Let Us Negotiate

Get a free OON claim review today. Our specialists will assess your outstanding out-of-network claims and show you exactly how much additional revenue we can recover at no cost and no obligation.
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Call Us Directly

650-240-0061

Email Our Team

business@rmbserv.com

HIPAA Certified
US-Based Team
85% Avg Reimbursement Increase
NSA & IDR Experts
30-Day Avg Resolution
Performance Based Pricing
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