When reducing bill payments based on a PPO or Discount Contract the Explanation of Review (EOR) issued by claims administrator should display the name of the entity authorized to take the discount.
The entity listed on the EOR may be the same entity with whom the provider has a PPO or Discount Contract agreement. The entity listed on the EOR may also be different entity, not recognized by the provider, that is paying to utilize the PPO or Discount Contract agreement the provider signed.
When a PPO or Discount Contract reduction is taken, most EORs display a column showing the discount with some variation of “PPO Reduction”, “PPO Savings”, or “Network Reduction”.
Examples of where to find the PPO or Discount Contract Name
Sedgwick Claims Management Services
State Compensation Insurance Fund (CA)
Liberty Mutual Insurance
Zurich Insurance North America
Berkshire Hathaway Homestate Companies
Tristar Risk Management
Intercare Holdings Insurance, Inc.
AmTrust North America
Cannon Cochran Management Services Inc.
Insurance Company of the West
Keenan & Associates
Employers Compensation Insurance Company