Can an SCA be signed electronically?

Yes. Electronic signatures are valid under the ESIGN Act (15 U.S.C. ch. 96) and UETA where adopted. Ensure intent, consent, attribution, and reliable record retention are demonstrable for legal enforceability.

Do SCAs require notarization or witnesses?

Generally no for payer-provider agreements, but state-specific rules or payer policies sometimes require notarization or witnesses. Verify requirements with the payer and applicable state law before execution.

What makes an SCA enforceable?

Clear parties, unequivocal acceptance, defined services, and signatures by authorized representatives. Follow ESIGN/UETA standards and include a governing law clause to reduce disputes.

How long should I retain signed SCAs?

Retain for the agreement term plus applicable statutory periods: at least 3 years for IRS purposes, and 6 years for HIPAA-related records (45 CFR §164.530(j)).

What if a claim is denied despite an SCA?

Use the SCA’s appeal and dispute clauses, submit the signed agreement and supporting clinical records, and reference prior-authorization numbers during the appeals process.

Are there privacy considerations when eSigning SCAs?

Yes. When SCAs include PHI, ensure the eSignature platform supports HIPAA and a signed BAA, encrypts data in transit and at rest, and provides detailed audit trails.

Electronic Signature
Templates
Healthcare
Healthcare Single Case Agreement

Healthcare Single Case Agreement

This template is fully customizable. Edit the text, fill out the fields, and send it for signature. Give it a try!

HEALTHCARE SINGLE CASE AGREEMENT

Parties and Effective Date

This Single Case Agreement (SCA) is entered into by and between Provider: and Payer: .

Effective Date: Authorization/Reference No.:

Patient Information

Patient Full Name

Date of Birth:

Gender:

Phone:

Patient Address Emergency Contact

Insurance and Coverage

Primary Insurer

Policy No.:

Group No.:

Subscriber:

Scope of Services and Clinical Justification

Description of requested services and clinical rationale. Provider certifies medical necessity for services described below and agrees to provide supporting documentation upon request.

Service Location / Setting Summary of Services Requested CPT / Procedure Codes (if applicable) Diagnosis / ICD Codes Clinical Justification (summary of medical necessity)

Rates, Billing and Payment Terms

The parties agree the services authorized by this SCA shall be billed and paid as set forth below. Payment is limited to services explicitly authorized in this Agreement.

Estimated Total Charges Agreed Payment Rate / Fee Schedule Billing Instructions & Timely Filing Requirements

Provider and Payer Obligations

Provider shall furnish services consistent with applicable licensure and standards of care and shall maintain accurate clinical and billing records. Payer shall reimburse for services in accordance with this Agreement and shall process claims and inquiries in good faith.

Provider Representative (Name & Title) Payer Representative (Name & Title)

Confidentiality, HIPAA and Release of Information

Each party agrees to comply with applicable privacy and security laws, including the federal standards for protection of health information. Provider is authorized to disclose to Payer such protected health information as is necessary to administer this SCA, process claims and coordinate benefits.

Patient Consent Obtained? Yes No

Term, Termination and Modification

This Agreement shall commence on the Effective Date specified above and shall expire on: unless earlier terminated in accordance with the terms herein. Either party may terminate for cause with written notice specifying the breach and providing an opportunity to cure as set forth below.

Notice Period for Termination (days)

Indemnification, Limitation of Liability and Dispute Resolution

Each party shall indemnify and hold harmless the other from liabilities resulting from its negligent acts or omissions in connection with performance under this SCA. Except as otherwise required by law, neither party shall be liable for indirect, incidental, punitive or special damages. Parties agree to submit disputes first to good faith negotiation and, if unresolved, to binding arbitration or the dispute resolution mechanism stated below.

Dispute Resolution / Arbitration Governing Law

Notices

All notices required or permitted under this Agreement shall be delivered in writing to the addresses below.

Provider Notice Address Payer Notice Address

Miscellaneous Provisions

This Agreement constitutes the entire agreement between the parties with respect to the subject matter and supersedes prior discussions. Any modification must be in writing and signed by authorized representatives of both parties. If any provision is held invalid, the remainder shall continue in full force and effect.

Additional Terms / Special Conditions

Attestations

By signing below, each party represents and warrants that: (a) it has the authority to enter into this Agreement; (b) the information provided is accurate to the best of its knowledge; and (c) it will comply with applicable laws and regulations in performing its obligations hereunder.

Provider

Printed Name:

By:

Date:

Payer

Printed Name:

By:

Date:

What the Healthcare Single Case Agreement Covers

A Healthcare Single Case Agreement (SCA) is a time-limited, payer-provider contract that authorizes reimbursement for a specific patient’s care outside an existing network or coverage scope. It defines the services approved, applicable rates, patient identifiers, effective dates, and any authorization limits. SCAs are commonly used for out-of-network referrals, specialty services, or one-off approvals where the payer and provider negotiate terms for a single episode of care. The agreement clarifies billing codes, prior-authorization references, and any documentation required for claims submission and payment.

Why an SCA Matters for Providers and Payers

An SCA protects both parties by documenting coverage terms, negotiated rates, and prior-authorization conditions. Properly executed SCAs reduce claim denials, set clear expectations for payments and appeals, and provide an auditable record of the authorization.

Who Typically Completes a Healthcare Single Case Agreement

Different stakeholders prepare and sign SCAs depending on role and responsibility.

Health plan contracting teams and medical management staff who approve one-off network arrangements and set reimbursement terms.
Provider contracting departments or billing managers who enter rates, CPT/HCPCS codes, and documentation requirements for claims.
Referring clinicians or utilization review nurses who initiate the SCA request with clinical justification and patient details.

The document is transactional: clinical, financial, and administrative stakeholders typically collaborate to complete and finalize the SCA.

Essential Parts of a Professional Healthcare Single Case Agreement

A clear SCA contains discrete sections that assign responsibilities, define covered services, and outline reimbursement and documentation requirements to reduce ambiguity at claims time.

Parties

Full legal names, billing names, tax IDs, and contact information for both payer and provider to ensure accurate attribution and remit routing.

Patient and Service

Patient name, DOB, insurance ID, service description, CPT/HCPCS codes, and clinical justification that define the single-case scope and covered dates.

Effective Term

Clear effective and expiration dates, including any retroactive coverage periods or single-episode limits that determine which claims are eligible.

Reimbursement Terms

Agreed rates (flat fee, percent of charge, or negotiated amount), payment timelines, and conditions for adjustments or retrospective reviews.

Documentation & Billing

Required clinical records, prior-authorization reference numbers, claim submission codes, and remittance instructions to support payment processing.

Dispute & Compliance

Appeals procedure, governing law, confidentiality clauses (HIPAA references), and signature blocks for authorized signatories and dates.

Step-by-step: Filling and Finalizing an SCA

Follow these sequential actions to prepare, approve, and archive a single case agreement.

01

Gather Info: Collect patient, service, and payer identifiers before drafting.
02

Draft Terms: Enter codes, rates, effective dates, and documentation requirements.
03

Internal Review: Get clinical and billing sign-off to confirm scope and codes.
04

Execute: Obtain authorized signatures from payer and provider and retain signed copy.

Where to Submit and How Routing Works

SCAs are routed to the payer’s contracting or medical management team, then to provider billing. Follow the payer’s submission channels below.

Email Submission: Attach signed SCA and supporting clinical records per payer instructions.
Secure Portal: Upload to payer web portals when available for faster routing and tracking.
Fax or Mail: Use only if the payer requires paper; include cover sheet with prior-authorization number.
Billing Upload: Submit claims with SCA reference and authorization numbers to prevent denials.

Customizing an Online SCA Workflow

Standardize an online process to reduce manual steps and ensure required fields are completed before routing.

Field	Configuration
Patient ID	Required; validation against payer ID format
Service Codes	Mandatory fields with dropdown CPT/HCPCS lookup
Effective Date	Date picker; format MM/DD/YYYY
Signature	eSignature field with audit trail enabled

Digital Signing and Platform Essentials

Use a secure eSignature platform that supports audit trails, authentication, and HIPAA controls when handling PHI.

Integrations: EHR and billing system connectivity
Security: AES-256 at rest; TLS 1.2/1.3 in transit
Authentication: Email, SMS, or stronger signer verification

Ensure the platform chosen provides retention, export, and audit capabilities to meet regulatory and payer recordkeeping requirements.

Required Data Elements and Security Notes

Patient Identifiers: Full name, DOB, member ID

Provider IDs: Tax ID, NPI, billing name

Service Data: CPT/HCPCS codes

Audit Trail: Timestamp, IP, signer email

Encryption: TLS 1.2/1.3 in transit

Data at Rest: AES-256 encrypted

Potential Risks and Consequences of an Incorrect SCA

Claim Denial: Denied payment due to incorrect codes

Repayment Demand: Provider may be liable for overpayments

HIPAA Violation: Improper PHI handling may incur penalties

Contract Invalidity: Missing signatures can render agreement unenforceable

Appeal Delays: Lack of documentation slows appeals

Audit Exposure: Inadequate records increase audit risk

Common Preparation Mistakes to Avoid

Using informal or vague language for reimbursement terms that leaves room for differing payer interpretations.
Failing to include exact CPT/HCPCS codes and modifiers, which often causes automated claim rejections.
Omitting the prior-authorization number or clinical justification that links the SCA to a specific approval.
Not retaining a signed copy with an audit trail, which complicates appeals and audits.

Comparing eSignature Vendors for Healthcare SCAs

Key platform differences affect HIPAA readiness, pricing model, and bulk sending. signNow is listed first to align with platform comparison conventions.

	signNow	DocuSign	Adobe Sign	PandaDoc	HelloSign
Starting Price	$8/user/mo	$15/user/mo	$14/user/mo	$19/user/mo	$15/user/mo
Free Trial	7-day free trial, no card	Varies by vendor	Varies by vendor	Varies by vendor	Varies by vendor
Bulk Send	Yes	Yes	Yes	Yes	No
Audit Trail	Yes	Yes	Yes	Yes	Yes
HIPAA Compliant	Yes	Yes	Yes	No	No
Envelope Cap	No cap	100 envelopes/user/year	Varies	Varies	Varies

Real-world SCA Examples and Outcomes

Two brief examples illustrate how institutions used SCAs to secure coverage and streamline billing for out-of-network services.

Fertility Centers of Illinois

John Butler, Founder, used eSign workflows to centralize single-case approvals and reduce turnaround time by eliminating paper reliance.

The SCA included CPT codes and documentation checklists for IVF claims.
As a result, the center improved claims acceptance and shortened payment cycles while maintaining HIPAA controls and an auditable record.

BIS

Dan Rotelli, CEO, implemented SCAs for specialty imaging referrals to prevent denials.

Agreements specified negotiated rates and prior-authorization IDs.
This reduced administrative appeals and improved cash flow predictability by clarifying reimbursement and documentation expectations up front.

Frequently Asked Questions About Healthcare Single Case Agreements

Answers to common SCA questions covering legality, signatures, retention, and typical execution issues.

Need help? Contact support

Can an SCA be signed electronically?
Yes. Electronic signatures are valid under the ESIGN Act (15 U.S.C. ch. 96) and UETA where adopted. Ensure intent, consent, attribution, and reliable record retention are demonstrable for legal enforceability.
Do SCAs require notarization or witnesses?
Generally no for payer-provider agreements, but state-specific rules or payer policies sometimes require notarization or witnesses. Verify requirements with the payer and applicable state law before execution.
What makes an SCA enforceable?
Clear parties, unequivocal acceptance, defined services, and signatures by authorized representatives. Follow ESIGN/UETA standards and include a governing law clause to reduce disputes.
How long should I retain signed SCAs?
Retain for the agreement term plus applicable statutory periods: at least 3 years for IRS purposes, and 6 years for HIPAA-related records (45 CFR §164.530(j)).
What if a claim is denied despite an SCA?
Use the SCA’s appeal and dispute clauses, submit the signed agreement and supporting clinical records, and reference prior-authorization numbers during the appeals process.
Are there privacy considerations when eSigning SCAs?
Yes. When SCAs include PHI, ensure the eSignature platform supports HIPAA and a signed BAA, encrypts data in transit and at rest, and provides detailed audit trails.

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