ProEnrollment

Out-of-Network Negotiation & Single Case Agreements

What Is a Single Case Agreement?

A single case agreement (SCA) is a one-time authorization from a payer allowing a non-participating (out-of-network) provider to see a specific patient at a negotiated rate. SCAs are used when: a patient needs a specialist not in-network, a provider is completing credentialing and hasn't received their effective date, or the payer's network doesn't include your specialty in the patient's area. insurance contract negotiation services.

How to Negotiate a Single Case Agreement

  1. Patient or provider contacts payer's out-of-network department
  2. Request a single case agreement for the specific CPT codes planned
  3. Negotiate rate — typically 100–130% of Medicare fee schedule
  4. Get authorization number and written rate confirmation
  5. Document everything before seeing the patient
  6. Bill with out-of-network claim procedure

SCAs are temporary — they don't create ongoing in-network status. For ongoing in-network participation, full credentialing is required. get credentialed with ProEnrollment.

When an SCA Is the Right Tool

Single case agreements solve specific situations: a patient needs your subspecialty and the payer's network lacks it locally, you're mid-credentialing and a patient can't wait for your effective date, or continuity of care justifies an exception (the patient was yours before a network change). SCAs are not a business model — payers track providers who rely on them and eventually force the credentialing question — but as a bridge they protect both revenue and patient relationships.

Negotiating the Rate

SCA rates are genuinely negotiable because the payer's alternative is a network adequacy problem. Anchor to a percentage of your billed charges or a multiple of Medicare (120–150% of Medicare is a common landing zone; behavioral health and scarce subspecialties command more). Get everything in writing before the visit: authorization number, covered CPT codes, rate, number of sessions, and effective dates. Verbal SCA approvals have a way of evaporating at claims time. For recurring out-of-network volume with one payer, the data from your SCAs becomes leverage for an in-network contract at favorable rates. Contract negotiation services | get in-network instead | closed panel strategies.