Three Rivers Provider Network Physician Solicitation --> was RE: weird unsolicited fax

[Guest guest]

Check out this google on them...yikes!

http://tinyurl.com/5zb3cv

Annie, you might want to make sure you aren't somehow accidently contracted with them and taking lower payments than you should.

It would behoove us all to search ourselves and see if we are on the list.

https://repricing.trpnppo.com/ProviderSearch.aspx

Locke, MD

More info below...

http://www.ama-assn.org/ama/pub/category/17552.html

Alert: Three Rivers Provider Network Physician Solicitation e-mail story | print story

The AMA has received numerous complaints from state medical associations about solicitations from Three Rivers Provider Network to physicians. These solicitations appear to be a routine request for a W-9, or a request for a National Provider Identification Number.

In fact, if signed, it will result in the physician practice agreeing to be "in network" with Three Rivers and agreeing to accept 25% discounts off their fees.

The AMA sent a letter (PDF, 245KB) to Three Rivers outlining its concerns about this solicitation and urging Three Rivers to make its contracting practices transparent.

We encourage you to alert your practice staff to be on the lookout for these solicitations and to only sign the document the practice wishes to participate in the Three Rivers network.

Read the AMA's letter to Three Rivers. (PDF, 245KB)

http://www.naswnyc.org/Private%20practice%20committee/specialalert.html

Special Alert For Private Practice Members - Three Rivers

(October 2007)

Earlier in the year, NASW-NYC began receiving complaints from its members in private practice about solicitations from Three Rivers Provider Network (TRPN, www.trpnppo.com), to elicit confidential information from them. After further investigation we also learned that members of the Medical Society of the State of New York were also experiencing the same concerns. With input from NASW-NYC’s Private Practice Committee, the Chapter advocated and sent letters to the offices of NYS Attorney General Cuomo and Mr. R. Dinallo, Superintendent for the New York State Insurance Department, requesting a review of the business practices of Three Rivers Provider Network and the insurance companies it represents, including United Healthcare, among others.

The letter expressed that our members have complained that they have received multiple “robo-call” telephone messages from TRPN asking for providers to share their IRS tax identification number and W9 along with other information. The Chapter communicated that members received as many as ten or twenty such messages, sometimes on a daily basis, which members found to be vague and, in some cases, intimidating, as it referred to IRS requirements. In addition, when some members responded by calling the number provided, the only option given was to submit their fax number; there was no opportunity to speak with a TRPN representative for information or clarification. There was no indication of who TRPN represented in neither the original robo-call nor the second message. Most clinicians had never before heard of TRPN and had no prior dealings with them; TRPN did not provide any indication of what insurance companies they were representing in this transaction.

Some clinicians, misled by the original robo-call and the first paragraphs of the form to believe that in completing the form they were providing TRPN with a tax ID number to comply with IRS requirements, were later surprised to discover that in completing the form they had been enrolled to accept reduced fees for their services, which had not been what TRPN originally emphasized in their telephone robo-call. It appears that TRPN misled these clinicians into signing a managed care contract.

When these clinicians discovered what had happened and found a way to contact TRPN, they were told that they must wait 90 days in order to be released from this contract, and, in the meantime, that they must accept the reduced insurance reimbursement. One clinician, who threatened to engage a lawyer, was immediately released from the contract; however, not everyone has this option.

In its letter, NASW-NYC further expressed that the TRPN robo-call message and the subsequent letter from TRPN was confusing and resulted in clinicians feeling lured into unwittingly accepting a reduced fee for their services, and then making it unnecessarily difficult for them to withdraw from this arrangement. NASW-NYC called upon the Attorney General’s Office and the NYS Insurance Department to take action to prevent TRPN and the insurance companies that they represent from continuing to solicit clinicians in this manner, to promptly release any clinicians who request to be released from the contract signed and to reimburse any clinicians who request reimbursement for the reduced insurance payments that they were paid.

Since sending the letters, NASW-NYC has received responses from the NYS Attorney General indicating that they would be beginning a review with Three Rivers and from the State Insurance Department indicating that they would investigate the case. The Chapter will keep its membership updated as any new information becomes available.

naswnyc@... Telephone:

http://www.ama-assn.org/amednews/2007/06/04/bisb0604.htm

Physicians say PPO network's fax masked 25% pay cut

Organized medicine criticizes a W-9 request by Three Rivers Provider Network that also authorized lower reimbursement.

By G. Bethely, AMNews staff. June 4, 2007.

The AMA and several state medical societies are engaged in ongoing discussions with a PPO network that sent a fax to physicians that appeared to be a routine request for tax information -- but also bound physicians to having their reimbursement cut by 25%.

San Diego-based Three Rivers Provider Network sent the fax to physicians who had treated member patients, but who were not part of any TRPN network. TRPN not only has direct contracts with physicians, but also rents networks from other PPOs -- a practice which organized medicine has criticized as a "silent PPO" because physicians never negotiate rates with a plan, yet find themselves in it because they have signed a deal with a PPO that has rented out its network to someone else.

The TRPN fax noted that IRS regulations require that it "maintain a current taxpayer identification number on file for all providers of services," and provided a fax number to which physicians could return the form.

However, the TRPN fax also contained a paragraph stating that physicians would agree "payment of services will be 75% of provider's total billed charges for covered services." Physicians would sign one form; there was no opportunity to opt out of or negotiate the cut.

It's not uncommon for H. Rosenblum, MD, an ophthalmologist in Nashville, Tenn., to receive a random fax from an insurance company asking him to fill out a W-9, so when Dr. Rosenblum received the TRPN form, he said he signed the document without much hesitation. Several months later, while conducting a spot check of his claims receipts, Dr. Rosenblum noticed he wasn't getting his normal fee from the insurance companies with which he contracts.[...]