Please confirm member-specific billing information with the Care Navigation team. They will provide you with any information pertaining to copays or session limits.
There is no need to verify insurance; you’re in-network with TPN.health for all referrals we send you!
Do not bill insurance or clients when you provide services to TPN.health referrals. This is very important.
Submit all invoices to TPN.health under Invoices and Reimbursements tab on your TPN.health profile. Instructions linked here.
Ensure your payment information is correct on your TPN.health profile. Instructions linked here.
TPN is designated as the exclusive behavioral health carve-out entity under this member’s insurance plan. TPN is responsible for managing, authorizing, and processing all claims related to the member's behavioral health services.
Critical Billing Requirement: If your practice has historically submitted claims for this member's behavioral health services to their primary insurance carrier or any other payer, this process must now cease immediately. Upon receipt of referrals from TPN, all future claims for behavioral health services must be submitted exclusively to TPN using our invoicing feature.
Consequences of Non-Compliance: It is imperative to follow this instruction to ensure timely and accurate payment for the services rendered. In the event that a claim for behavioral health services is submitted to a payer other than TPN (e.g., the member's health plan):
Non-Network Rates May Apply: The claim will be processed according to that payer's standard rates and contractual agreements, which may be different—and potentially lower—than TPN rates.
Incorrect Patient Cost-Share: The member's responsibility (copays, deductibles, coinsurance) will be calculated based on the other payer's benefit structure, not TPN’s. This could result in an incorrect copay or inaccurate balance being billed to the member.
Delayed Payment and Administrative Burden: Submitting claims to the incorrect entity may lead to claim denials and necessitate time-consuming resubmissions to TPN, significantly delaying payment to your practice.
Action Required: Please update your staff and billing systems to reflect that TPN is the sole payer for this member's behavioral health services moving forward. Use the invoicing instructions provided by TPN for all future services.
Late Cancellation and No-Show Policy: You are free to enforce your no-show and late cancellation policies and may collect member payment information for this purpose. TPN will not reimburse for no-shows and late cancellations, unless explicitly stated otherwise at the time of the referral.