A Single Case Agreement, or SCA, is one of the few mechanisms that lets a patient see an out of network provider without absorbing the full out of network cost. In practice, it can keep your schedule full, protect continuity of care, and keep families from walking away when they realize your clinic is not listed in their network.
For access, SCAs help when:
For your revenue and throughput, an approved SCA turns a near lost case into an active course of care with billable visits. It also gives your staff a defined route to reimbursement, instead of improvised one off appeals.
From a workload perspective, the way you manage SCA traffic matters as much as whether you seek them at all. Clinics that keep calls, emails, portal threads, and insurer messages scattered across different tools find that every SCA involves repeated status checks and rework. That is one reason many practices now look for a unified patient inbox and AI intake automation, the model described on the Solum Health home page and the Solutions section. When all the pre visit work is in one queue, Single Case Agreement negotiation becomes a managed workflow rather than an exception that lives in someone’s memory.
Single Case Agreement negotiation is the process of requesting, justifying, and securing a temporary contract between a health plan and an out of network provider for one specific patient. The agreement spells out which services are covered, at what rate, for what period, and under which conditions.
The core definition is simple:
Most plans expect you to explain why care cannot reasonably be delivered by someone already in the network. That can be a shortage of appropriate providers, long wait times, a narrow specialty such as intensive behavioral therapy, or the need to preserve continuity of care after a plan change. In other words, an SCA is a safety valve inside the usual network design, and the negotiation is how you make the case to open it.
Although every insurer has its own playbook, the process usually follows the same arc.
First, you identify that an SCA is appropriate. A scheduler or intake coordinator realizes that the patient’s coverage treats your clinic as out of network and that there is no realistic in network option that meets clinical and timing needs.
Second, you assemble justification. This usually includes a concise clinical summary, the treatment plan or evaluation notes, and a record of attempts to find in network providers, including wait time information and distance when that is relevant.
Third, you submit the request through the channel the plan requires. Some rely on a portal, some still expect fax, others use email or a structured phone review. The packet will generally include:
Fourth, you negotiate terms. The plan may come back with a rate tied to its internal fee schedule, a limited number of visits, or a shorter time period than you requested. You can often respond with clarifying information and, in some cases, a counterposition when you have strong clinical or operational reasons.
Fifth, you insist on written confirmation. This is the part that prevents future billing disputes. Verbal approvals feel encouraging, but they do not give your revenue cycle team anything to rely on when claims are processed.
Finally, you start services under the agreement and track utilization against the authorized units and dates. Some clinics tie that tracking to their practice management system and their messaging hub, which is where a unified inbox model, the one described in the Glossary and on the Blog, can protect staff from missed end dates and avoidable denials.
Is a Single Case Agreement the same as prior authorization?
No, a Single Case Agreement allows an out of network provider to deliver covered services for a specific patient, and prior authorization is a separate approval for particular services or codes that may still be required even after the SCA is in place.
How long does Single Case Agreement negotiation take?
Time frames vary by plan. Some agreements are approved within a few days, others take several weeks, especially if the insurer requests additional documentation or has a backlog.
Can insurers deny a Single Case Agreement request?
Yes. Common reasons include available in network providers, unclear medical necessity, or missing documentation. Many plans allow you to appeal or resubmit with more complete information.
Do Single Case Agreements guarantee payment?
They protect you only when the terms are documented in writing and you bill exactly within those terms. Verbal assurances do not guarantee payment, and billing outside the authorized codes or dates can still result in denials.
Do Single Case Agreements apply to all service types?
Many plans allow SCAs for therapy, behavioral health, and other outpatient specialties, but specific rules vary by insurer and by benefit design, so you should verify criteria for each plan before submitting a request.
If you want to improve how your clinic handles Single Case Agreement negotiation in the next few weeks, you can keep the steps modest and practical.
First, pick one plan that you work with frequently and one high volume service line, and write a short SCA policy for that slice of your operation. Second, create a standard packet checklist and a simple tracker, even if that starts as a spreadsheet that you later fold into the same AI powered front office and unified inbox model that Solum Health describes on its main site and in the Solutions overview. Third, run a small pilot, review a handful of cases at the end of the month, and refine the criteria and scripts your staff use.
Handled this way, Single Case Agreement negotiation becomes a structured workflow that supports access, keeps throughput steady, and respects the finite capacity of your front office rather than another exception that burns out your team.
