Out of Network IRON

Why is Out of Network Signed Agreement an important Tool?

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ICS has developed its own internal Out of Network Signed Negotiation business model, called IRON, focusing on those medical bills that do not hit a PPO and meet certain dollar threshold and/or bill type criteria.

ICS utilizes two techniques when managing an out of network large bill, we either apply values inherent in our proprietary databases to bills that meet the pre-defined criteria and recommend a “fair and reasonable” value to be paid or we utilize our Nurse Auditors/Code Reviewers to negotiate bills that cannot be reduced through other means.

In either model, ICS always obtains a signed agreement from the medical provider to ensure that the agreed upon amount is never in question downstream which will eliminate disputes and arbitration and assist with reserving and total medical cost on a given claim, giving credence to the business models name of IRON, or Increased Results on Negotiations.

Out of Network IRON – Signed Agreement Business Model

  • Recommended referral criteria: Any medical bill that comes back without PPO savings and over $1,500.00 in Charge Amount should be flagged for consideration
  • Utilize proprietary application to identify past payment trends to establish appropriate negotiation baselines
  • Our negotiators talk with providers to arrive at a mutually acceptable reimbursement within the regulatory parameters that apply, based on our benchmark data.
  • A signed settlement agreement is obtained from the authorized provider representative to prevent legal disputes, reconsiderations and to aid in proper reserving of the claim.

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