Important information about TRIARQ Health’s free claims assessment:

• We need your permission to get your data from CMS to complete the assessment. 
• There is a short window when we can request this data, and once you sign our confidentiality agreement, we will work with you to submit the request.
• We cannot accept any requests after May 27th.
• We expect CMS to release this raw data in September.
• We should have the financial assessment ready to review with you in late September/early October.

 

Please complete the following non-binding form granting TRIARQ Health permission to request your practice’s historical data from CMS.  TRIARQ Health will keep your data confidential and will not be shared with any other parties.

TRIARQ Health will use your historic CMS data to outline the benefits you may get entering into a contract with TRIARQ Health.  Recommendations may include but are not limited to contracting with TRARQ Health for prior authorization support, RCM, billing, and coding or joining TRIARQ Health’s BPCI-Advanced Alliance.

Non-Binding Statement-of-Interest

Until you sign a binding contract with TRIARQ, both parties have the right to terminate all negotiations regarding TRIARQ Health’s practice management services and/or the BCPI-Advanced Program without any liability or obligation to move forward. This is not a binding agreement.

This Statement of Interest is made as of the date signed below by the undersigned Physician Group Practice (“PGP”) to TRIARQ LLC. (“TRIARQ”).

1. I understand that this is an indication of interest only at this point. It is a non-binding commitment on my part and does not create any obligation to TRIARQ but will be used by TRIARQ to discuss TRIARQ Health’s practice management services and/or discussions with CMS and/or Commercial Payers to determine participation in the BPCI Advanced Bundle Payment Program, Commercial Bundled Payment Programs or other.
2. Any binding commitment by me will be made only after I receive a contract, participation agreement or offering memorandum, and TRIARQ and I sign all necessary legal documents and other materials, which TRIARQ will present for my final approval.
3. I hereby grant Triarq permission to request and receive historical data from CMS regarding PGP performance.