Single Case Agreements

HEOPS offers call center staffing on a full time or project basis for network development, provider Single Case Agreements commonly referred to as SCA are one time agreements between a health plan/payor/third party administrator and a healthcare provider.

SCA are typically negotiated at the time of care. Often due to out of network access or other situations that prohibit a real time SCA, the healthcare provider may be approached prior to payment for care.

How it Works.

HEOPS contracts with payors to either provide real time or retrospective SCA negotiations with Business Rules established by the payor. HEOPS is notified by the Client lead either electronically or telephonically then an SCA order is generated and the negotiation process begins with the provider.

Upon completion, all materials are scanned and returned electronically to the payor for processing. HEOPS maintains back up documentation on all negotiated SCA.

Cost:

Based upon the Business Rules and complexity, cost models can be flexed to meet Client requirements and may involve one or more of the following methodologies:

• Per Agreement
• Percentage of Savings
• Time and Materials.

Need More Information?

Contact Nancy Everitt via email or at 866-887-3677 for more information.