Out-of-Network, In the Money: Prior Auth Power Moves for Providers

Tackle denials, delays, and documentation errors with real-world solutions

Out-of-network (OON) billing and prior authorization hurdles remain two of the most challenging aspects of healthcare revenue cycle management. Healthcare providers and staff often find themselves stuck in a maze of denials, delayed payments, and unclear and inconsistent payer rules. This session is designed to demystify the out-of-network billing landscape and equip healthcare providers, administrators, and billing teams with real-world strategies to streamline the prior authorization process and secure appropriate reimbursement. 

Whether you’re navigating insurance pushbacks, managing patient expectations, or dealing with surprise billing challenges, this session will give you the tools and clarity you need to operate efficiently and compliantly. This session is built to deliver real-world, provider-focused solutions and not just theory, so that you can take back control of your billing and prior-authorization processes!

Webinar Objectives

This session aims to empower healthcare providers, billing professionals, and administrative teams with practical strategies to overcome the persistent challenges of out-of-network billing and prior authorization. Attendees will gain a deep understanding of payer-specific rules, documentation standards, and appeal tactics to minimize denials and accelerate reimbursement. By addressing common roadblocks—such as vague medical necessity criteria, surprise billing concerns, and inefficient workflows—this session will provide actionable tools to help participants streamline their processes, enhance patient communication, and maintain compliance while maximizing revenue.

Webinar Agenda

• Explain the key differences between in-network and out-of-network billing processes and requirements
• Identify the most common pitfalls in OON claims submission and reimbursement and how to avoid them
• Implement effective workflows for securing and tracking prior authorizations to reduce denials
• Develop communication strategies to set realistic patient expectations about cost, coverage, and timelines
• Apply best practices for documentation and appeals to maximize OON payment success

Webinar Highlights

• Step-by-step breakdown of the OON billing process from a provider’s perspective
• Explain how to navigate payer-specific nuances and authorization criteria
• Pro-Tips for clean claim submissions and proactive denial prevention
• Discuss real-world examples of successful prior authorization appeals
• Outline strategies for balancing compliance with patient-centered care
• Review updates on the No Surprises Act and state-level OON billing rules
• Q&A session to troubleshoot OON payer issues

Who Should Attend

• Medical Coding Specialists
• Medical Billing Specialists
• Medical Auditing Specialists
• Private Practice Physicians
• Managed Care Professionals
• Operations Leadership
• Practice Administrators
• Office Managers
• Compliance Officers/Committees 
• Chief Medical Officer