Print Open Negotiations Form

The Open Negotiations Form allows users to print an Open Negotiation Form (OMB 1210-0136) directly from the claim screen so that providers who are out-of-network can enter open negotiations with the insurance company to determine the amount that the insurance company will pay for emergency services.

1. Select Claim > Claim.

2. Use the Search field to search for your claim.  

   Place a check in the “Show exact matches only” box to search for exact matches or “Show unpaid claims only” to show claims that may need follow-up.

3. Open the claim.

4. Click the Print button.

5. Select Open Negotiations Form.

6. Enter the Signer's relationship to the office.

7. Enter the out-of-network rate offer to the desired percentage of the total amount and click Set.

8. Optional: You can also Enter/Edit the Offer for Total Out-of-Network Rate column for each individual service line.

9. Check the "Open Negotiations Period and IDR Initiation Deadline after Printing" box. 

   1. When checked, it will set and store the "Open Negotiations Period End" and Federal "IDR Initiation Deadline" dates when sending the Open Negotiations Form, making it easier for users to manage the Open Negotiations process. 

      This data will be stored and available within the "Open Negotiations" tab in the Claim Follow-Up Activity screen. 

10. Click

11. Click Save. Otherwise, click Close.