Beginning in early March, 2021, APS clients have been receiving checks from Three Rivers Provider Network (TRPN). These checks are for $15 and have the appearance of an Explanation of Benefits (EOB). Further review shows that this is in fact not an EOB, but a one-time participation payment from the Third Party Administrator (TPA). The second page of this correspondence is a participation agreement, which indicates that “Provider agrees that by cashing this check they will accept all terms and conditions of this ongoing settlement agreement.” This is a practice the TPA has employed in the past, which the AMA has previously addressed with TRPN.
Endorsement of the check and cashing with no other action means the provider will be in network with TRPN and the insurance companies that access the network when not directly contracted with a provider group. Reimbursement rates vary by provider based off the letter’s indication. In most cases, the contract indicates claims will be paid at, “the lesser of 30 percent off billed charges, 10 percent off maximum allowable or 200 percent of Medicare with no exceptions allowed.” Failure to identify this sort of tactic employed by TRPN could result in unfavorable reimbursement to your group from many payers, where you have opted to stay out of network due to unsatisfactory terms or payment rates.
Providers who have accidentally cashed these checks have 20 business days to notify TRPN and return the amount of the check. APS will continue to monitor this and all items affecting your reimbursement.