On September 22, 2017, the order approving the 1st Interim Claims Report was signed by the judge assigned to the Physicians United Plan, Inc. receivership. Notices of Determination (NODs) were mailed to all evaluated claims in classes 2-8 on October 17, 2017. Each NOD has a claims evaluation code listed on it that provides the basis of how the claim was evaluated. For a list of evaluation codes and their descriptions, please click here.
Important Information for Medical Fee-For-Service Providers - Updated August 25, 2016
The Receiver entered into a contract with a third-party administrator, MED3000 Health Solutions Southeast, to handle the processing of PUP unpaid claims.
On August 25, 2016, the Receiver sent notices with claim filing instructions to all known Medical Fee-For-Service Providers who may have claims unpaid by PUP. These notices were sent by email to the email on file with the NPPES database or by regular mail if no email was available. If you have not received a notice, please contact MED3000 Health Solutions Southeast by email, email@example.com or by phone at (844) 636-7501. Always include the provider name, tax ID and the NPI in your inquiry.
The Claim Filing Deadline for all Medical Providers was October 31, 2016
I am owed money for services provided before PUP was ordered into receivership. What is the procedure for payment of these claims?
On August 26, 2016, the Department sent approximately 17,890 Provider Notices regarding claim filing instructions. The majority were sent by regular postal mail and the remainder were sent via email message instructing medical providers to submit their outstanding claims against Physicians United Plan, Inc. (PUP). The deadline to submit outstanding claims is October 31, 2016,
I have provided services after the company was placed into receivership to a member of PUP. Who is responsible for paying these bills?
The company, Physicians United Plan, Inc. is responsible for paying services provided under the terms of its member agreements for claims occurring before June 1, 2014. Under Section 641.3154, Florida Statutes, HMO members/subscribers are not liable to any provider of health care services for any services covered by the HMO.
Can Providers seek payment from former members/subscribers for debt owed by PUP for medical services?
No. Under Section 641.3154, Florida Statutes, HMO subscribers are not liable to any provider of health care services for any services covered by the HMO. Additionally, health care providers and their representatives are prohibited from attempting to collect payment from the HMO subscribers for such services. If you are contacted by a health care provider for such payment, you should inform the provider of this law.