When news broke of the Independent Physical Therapists of California (iPTCA) lawsuit against Align Networks, we were hesitant to judge, but quick to point out that we weren’t exactly surprised. Over the last several years, we saw dozens of complaints about Align Networks from providers the state over. Almost weekly, we also receive support cases from clients asking for help with network payment problems. At that kind of volume, and in a field so stunningly complex, it’s difficult to readily identify trends. Were the complaints we received about Align Networks the signal? Or were they just noise? A discount Align contract available on the iPTCA website appears to help answer those questions.
When we receive complaints about networks, we inevitably direct our clients to review the contract they signed with the network, as signing this contract forfeits any rights granted to providers by California Labor Code. Sure enough, the Align contract shows substantial differences between Align and the DWC billing requirements.
To better understand the contract we’re about to review, it’s important to familiarize oneself with some of the most common grievances against Align Networks. We culled a few representative client complaints from over 50 support cases our compliance team has fielded about Align Networks in the last 18 months. The conversations have been lightly edited for style and clarity.
Align Networks is claiming that they aren’t receiving our bills. Can you please get a hold of them to see if there have been any changes to their electronic address?
Hello, I wanted to report a problem. I submitted some bills, but Align Networks claims not to have received them. Dates of service in March 2015 were billed and accepted on November 13, 2015, and even marked as processed. How could it be that Align never received these bills? Please help.
Hello. I was wondering if our bills for Align Networks can be emailed and not faxed. I seem to be having a constant issue with Align either not receiving our entire bills or the notes. Between two patients, I had eight dates of service missing with Align. I have not reported the errors as of yet.
We are having issues with Align Networks stating that they did not receive our claims. We are having to send out claims twice.
Hello. I am still having difficulties transmitting bills to Align Networks. They claim to be getting only the cover page, but not the actual bill. Why is this happening?
I recently submitted a bill to Align Networks. It looks like it was faxed. Align says they did not receive it. How do I go about verifying that they are receiving my bills?
Stop us if you’re sensing a pattern here. Align has a long history of strange “lost in the fax” problems.
Here’s some critical context, though. DaisyBill routes bills to Align Networks via a dedicated fax number that Align supplied. What’s more, our Bill History page includes a fax receipt that documents whether the bill and associated supporting documents were successfully transmitted. For each of the cases above, our records verify that Align received all the documentation necessary to process the bill. So the “lost in the fax” routine is truly puzzling.
Which brings us to Align’s Providing Provider contract on the iPTCA website. We’ll go through the contract in more detail in the weeks to come, but for now we’d like to focus on this provision:
“Participating Provider agrees to submit all claims within sixty (60) calendar days of the service date…. Align shall reimburse Participating Provider in forty-five (45) calendar days following receipt of each Clean Claim”
First, the time to payment. California Labor Code Section 4603.2 requires claims administrators to remit timely payment within either 45 and 60 days, depending on whether the employer is a government entity. Labor Code Section 4603.4 requires claims administrator to be even quicker with payment for electronically submitted bills and pay the provider within 15 working days of receipt of an accepted electronic bill.
If the claims administrator fails to remit timely payment, they owe the provider self-executing penalty and interest. But Align is not a claims administrator, and can therefore operate outside of the DWC’s regulations. To wit, the Align contract states that payment will be made to the provider in 45 days, but offers no restitution [a]to the provider when Align fails to remit timely payment.
For each of the cases noted above, Align failed to process the bills within the 45 calendar days required by their own contract. And since Align is not subject to DWC regulations, they aren’t required to pay penalty and interest.
Even more troubling, Align draws up its own rulebook about timely bill submission. Whereas newly enacted California Labor Code Section 4603 allows providers one calendar year to submit bills for payment, the Align contract only allows sixty days. It’s unclear whether there are any consequences if a provider fails to submit a bill to Align within this abbreviated timeline.
We should emphasize at this point that none of the allegations in the Align lawsuit have been definitively proven in court. Even so, we urge providers to take extreme caution when entering into a discount contract with Align – or any other network.
Our advice? If you do choose to enter into a discount contract, try to negotiate everything to match the DWC’s billing regulations as closely as possible. In the case of Align Networks, that means fighting for a full year to submit bills, as guaranteed by Labor Code 4603. It also means fighting for the penalty and interest provisions that protect other providers from late payment.
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 Because Align is not a claims administrator, they are not legally bound by the DWC’s e-Billing rules and regulations. Align does not accept electronic bills.
[a]Use a smaller word?