When TPAs Sign PPO Agreements… Action Must Be Taken
Dear Colleagues and Friends:
The line between claims processor and payor of claims has been blurred… and you may be at risk.
The Phia Group has often advised you regarding why it is in your best interest, as TPAs, to avoid signing PPO network agreements that identify you as a payor. Other TPAs are now dealing with the repercussions of this exact issue. TPAs are being sued by providers. Providers are pursuing TPAs for payment of medical claims. Courts are deciding that TPAs are responsible for payment. Startlingly, this is happening with greater frequency.
Yet, we understand that market realities require you to secure access to network discounts for your clients.
If you are a TPA that has signed a PPO agreement, and you do not have a joinder agreement executed by the Plan Administrator and PPO that unambiguously shifts payment responsibility from you to the Plan Administrator, please contact me or Adam Russo without delay. Adam can be reached at arusso@phiagroup.com or 781-535-5622. I can be reached using the contact information below.
Best regards,
Ron E. Peck, Esq. Sr. Vice President & General Counsel The Phia Group, LLC 163 Bay State Drive Braintree, MA 02184 Phone: 781-535-5617 Fax: 781-535-5656
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