More and more often, physicians are being targeted by misleading advertisements and network agreements from third-party networks – also known as “repricing companies” or “repricers.”
These third-party repricing companies, like MultiPlan, Zelis, Zenith, First Health or TRPN (also known as Three Rivers), often solicit physicians by calling their office or billing staff and by sending single case agreement offers designed to make physicians think that certain forms need to be filled out in order to obtain payment for patient procedures or surgeries. All too often, these advertisements are disguised contracts (sometimes global contracts) seeking consent to “reprice” your claims for reimbursement.
Patients’ insurance cards now have little symbols on the back for “MultiPlan” or “Three Rivers” or other repricing companies that may be accessed by insurance. Even if physicians already have an express agreement with MultiPlan, for example, insurers may disregard the agreement (after services have been provided to the patient) and then access the insurer’s own agreement with MultiPlan and reimburse at a lower rate than the contract states.
Physicians who try to appeal and seek application of their contracted rate may be told that insurers apply a different rate “at our option” based on the patient’s plan documents.
Important things to keep in mind:
- Check patients’ insurance cards for symbols.
- Be careful of contracts disguised as single case agreements. There could language in the single case agreement which states that it is actually a global agreement.
- Be sure to read the fine print before signing anything, and if you are not sure about the effect of a single case agreement, ask us to review it.
Keep in mind that third-party repricing networks appear legitimate and may have claims information, including dates of service and procedures.
For questions regarding this update, please contact us at (310) 203-2800 or contact:
Katherine Bowles
[email protected]
Jonathan Stieglitz
[email protected]