It has been brought to our attention that members may be receiving checks and letters like the one attached to this Alert. If you endorse and cash this check, you have entered a contract with this payer. This payer is not one from the IPA!
This contract is dramatically skewed in the payer’s favor (as most tend to be). I have highlighted several items in the document to draw your attention to, but by no means is what I’ve highlighted the extent of the unfavorable terms for practices. Let’s review what’s highlighted, and again, these are by no means the extent of the concerning terms:
See the Attached document below:
Admin instructions San Juan IPA
- Note the company name for reference: DirectPay.
- In the first line, notice that cashing this check is acceptance for network participation.
- In the second line, if you cash the check you are accepting all the terms of the agreement.
- On the third line, note that this applies to all lines of business that may contract through DirectPay.
- In the seventh (7th) paragraph, note that they charge the provider 7% interest on any overpayment.
- In the eighth (8th) paragraph, note that there is a 20-business day grace period should you cash this check in error. This is significant because on the check itself it says you must contact them in 10 business days.
- In the ninth (9th) paragraph, note that this is a 3-year term, and the provider must give 6 months’ notice for termination. In addition, this contract is construed under the laws of Nevada, not New Mexico. Finally, all disputes are handled
in Nevada, inclusive of to “meet and confer” and binding arbitration. - In the eleventh (11th) paragraph, the provider must maintain $5,000,000 of liability coverage. This is excessive and does not consider the New Mexico Medical Malpractice Act.
- On the check, again notice that this is a participation payment, and again, notice that the term to notify is different.
Things that are not in this agreement:
- There is no timely payment rule. The provider has no idea how long it might take to get paid.
- There is no recoupment rule. The payer may come at any time for recoupment, and interest has been accruing during that period.
- DirectPay is not the payer. There could be multiple payers going through DirectPay.
A shout out to Danielle at Four Corners Spine and Pain for bringing this to our attention!!
Casey Crotty
Chief Executive Officer
San Juan IPA and Affiliates
