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  • One Call Care Management to Change Referral Practices as Result of Court Settlement

    A third-party provider network manager in California has changed the ways it works with physical therapists (PTs), thanks to a successful settlement agreement stemming from a lawsuit brought forward by the Independent Physical Therapists of California (iPTCA).

    The original lawsuit alleged that One Call Care Management engaged in a number of unfair business practices around referral for PT services. Under a settlement reached in late 2017, One Call has been directed to modify its patient referral and authorization process, increase transparency around its scoring of physical therapists, and enhance its electronic billing and payment system. A summary of the changes included in the settlement is now available.

    One Call began implementing the payment policy changes, which are specific to California, in February. APTA and the California Chapter endorsed the lawsuit, which also received donations from the Private Practice Section of APTA. . Individuals who have compliance disputes should email iPTCA at admin@iptca.org.

    Comments

    • One call needs to be investigated by the State for Im glad you won your lawsuit however there is Fraud in all areas not just physical therapy. DME Language, translation, MRI , transporation , medication, surgery...they have squeezed out every vendor to pulp, even out of busines for their greed and gain!! How can they have all the Insurance Companies in their pokets who is making$$$$ . Definitely Sacramento

      Posted by cshrednick on 10/5/2018 2:38 PM

    • I have 3 Physical Therapy Clinics in Philadelphia; have had the City Municipal contract since 2000 to present, recently the City awarded the contract to PMA as their third party administrator. PMA uses One Call to manage all their referrals. I have since been squeezed out and get a trickle of patients from one Call, maybe 1 -2 per month. They are not transparent with their score card, so I can evaluate the other PT/OT providers who are now getting 98% of the referrals

      Posted by Luis Hincapie on 1/23/2019 8:27 AM

    • Let me start by saying that our company has been contracted with One Call/Align for over 10 years. All of a sudden we are no longer getting any direct referrals from them. They only time we get a One Call patient is when they happen to be referred directly to us from the physician and even then, One Call has attempted to take them away from us and refer them elsewhere. I knew I needed to speak with their Provider Relations department so I attempted to call them. After 3 attempts and still not getting through to anyone there, I finally had to demand to speak to anyone who could help me. I was finally connected to someone in provider relations and asked them what was going on and why we are not receiving referrals anymore . They told me it was due to our "Score Card". I asked them to please explain to me in detail what each score entailed and how we can correct it. They told me nothing could be discussed at that time and I would have to wait for someone to call me back and talk to me about it. I have not received a call back and I still have no idea what it is they want from us. I am sick and tired of the games One Call plays with providers. We are in good standing with Medrisk (with two PT's we receive upwards of 5 referrals a day) so what's up with One Call?! They will not tell us anything.

      Posted by Christy on 2/22/2019 3:14 PM

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