It has come to our attention that a company doing business as “Three Rivers Product Network” or “TRPN Direct Pay” is sending out documents purporting to be Business Associate Agreements (“BAAs”) to ambulance services across the country. This company is claiming that the BAA is required to be signed by ambulance service providers in order to “review” claims submitted to “members” of TRPN’s payer network. These BAA agreements contain dangerous provisions; do NOT sign them. 

In this case, the document sent by TRPN is NOT a standard BAA.  In most respects, it does look like a standard BAA. However, included in paragraph 18 of the version of the BAA we have seen, they have the following provisions: 

• That reimbursement of claims shall be limited to the lesser of several options at their discretion, including 35% less than billed charges, 80% of “usual and customary” charges, and other amounts which would be less than what the ambulance service would otherwise be entitled to.
• Language stating “All claims shall be processed through this Agreement on an exclusive basis”; and
• “All discounts granted by Provider shall be fully assigned to TRPN Direct Pay”. 

While it is unclear exactly what their intent is, from this language, it appears that they are trying to get ambulance service providers to agree to discounts, then they would seek to keep the difference in the discounted amount and what insurance would have otherwise paid. All of paragraph 18 is extremely concerning, and this is not the first time that TRPN Direct Pay has had its intentions and business practices questioned. Several years ago, the California Medical Association issued this statement: CMA demands TRPN immediately cease illegal $15 check scheme, and the State of Georgia required them to cease and desist similar improper business practices: Commissioner King Takes Action Against Nevada-Based Company | Office of the Commissioner of Insurance and Safety Fire.  Now it seems like TRPN has come up with a new scheme to slip payment limitations and assignment language into a “BAA” and then use that Agreement to reduce payments, and possibly insert themselves as the exclusive administrator of your claims. 

As a general matter, any company working as a claim processing or re-pricing agent for an insurance payer would not be performing a business function for the ambulance services and therefore would not need a BAA directly with the ambulance service provider. Instead, they should be entering a BAA with any payer with whom they work as a vendor. Also, as a general rule, if there is ever a need for a BAA, then it is not up to the business associate to dictate the terms of the BAA; the covered entity should require the business associate to sign the covered entity’s standard BAA. Any time you receive a BAA from a third party, you should carefully read the terms or have us review it for you; these are enforceable contracts and come with potential consequences for your company. 

Our advice is NOT to sign any BAA agreement sent to your company by TRPN Direct Pay. If you receive one, please let us know and give us the opportunity to review on your behalf. If you have already signed and returned one of these agreements, please contact us so that we can take steps to terminate that agreement for you.