DaisyBIll providers report receiving incorrect and very confusing denials from MedRisk, a managed care provider network, for bills that were actually submitted directly to AIG.  The MedRisk denials state: “Not currently a participating MedRisk provider. Please submit bill directly to insurance carrier.”

Frequently Asked Question

Q: Why am I getting a confusing denial from MedRisk when I submitted my bill to AIG?

A: Network contracts are notoriously difficult to track, for both providers and payors. It’s likely you signed a managed care network contract with either MedRisk or a different network that then sold or shared your contract with MedRisk or a MedRisk affiliate.

In the latter case, your original contract may have allowed this sale or sharing without consent or even notification.

Explanation

The AIG / MedRisk situation is the most recent egregious example of payor confusion when it comes to network contracts. In this case, the provider correctly sent the bill to AIG. However, AIG then sent the bill either:

• Directly to MedRisk
• Indirectly through a related or affiliate MedRisk network (such as Stratose Network - now Zelis, Multiplan, etc.), with which the provider contracted. The related / affiliate network then sent the bill to MedRisk.

Next, MedRisk sends the bill back to the provider if the provider is not contracted with MedRisk, with the following denial reason: Not currently a participating MedRisk provider. Please submit bill directly to insurance carrier.

The provider’s dilemma is impossible because of the circular nature of the problem (AIG → MedRisk → AIG, and so on), with the provider getting bounced between AIG and MedRisk without the bill ever being resolved.

When a provider signs a managed care network contract, the provider abdicates many of his or her rights because these networks are not regulated by California’s Division of Workers’ Compensation (DWC). Once a provider signs a network contract, the claims administrators that use the networks are no longer obligated to abide by the DWC regulations put in place to protect providers.

This is why we urge caution and care when considering network contracts. Carefully review the terms of each contract. Often the terms allow the network to sell / share signed contracts with other networks and multiple claims administrators. Accordingly, a single signed contract may obligate a provider to many claims administrators and other undisclosed networks.

Additional Information

Please contact us directly if you have additional questions.