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Incorporate due diligence into your contract

When you contract with an administrative services organization (ASO) or PPO, the ASO or PPO acts as an agent for the principal payer (and a fully disclosed one at that). Try as you might to secure payment guarantees from a plan, you are unlikely to obtain any such guarantees. In fairness, the plan is not being paid a premium to cover a risk; instead, it's paid a fee merely to serve as the claims administrator. Understand that you, the provider, assume this risk of nonpayment. Although you might be able to seek legal recourse against either the payer or the member, lawsuits are expensive and time consuming and thus not cost effective unless the sums due are extensive.

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