Rental and Leased Networks, and How to Get Out of One

Introduction

A rental or leased network contracts with healthcare providers for discounted rates, then gives insurers, third-party administrators, employer plans, and other payers access to those rates. The network usually is not the insurer named on the patient’s card and may not adjudicate or pay the claim. Its role is to supply the contract rate used by the claims administrator.

This arrangement can be legitimate and commercially useful when the network brings meaningful patient access at acceptable rates. It becomes a problem when a practice receives little steerage, cannot identify who can use the discount, or discovers that claims are being repriced under terms no one currently managing the practice remembers approving. The American Medical Association describes rental networks as PPOs that lease their provider panels and associated discounts to other payers.

This issue matters most to practice owners, RCM directors, and compliance teams seeing unexplained contractual write-offs, unfamiliar network names on remits, or payments below the rates in their direct payer contracts.

The major rental and leased networks practices encounter

The company named on the patient’s insurance card, the administrator processing the claim, and the network supplying the rate can be three different entities. That separation is why contract access is easy to miss.

Network structures and names are documented in the Claritev provider resources, the Aetna provider manual for First Health and Cofinity, the HealthSmart provider manual, and Three Rivers Provider Network.

How a practice ends up in a leased network without realizing it

A stand-alone agreement was signed years ago

A founder, former administrator, acquired practice, or management company may have signed a separate PHCS, First Health, HealthSmart, or TRPN agreement. The contract can remain active even after the employee who understood it leaves.

A direct payer contract contains a network-leasing clause

A commercial payer agreement may authorize the payer or an affiliated network to sell, rent, or grant third-party access to the practice’s services and rates. The clause may sit under headings such as “third-party access,” “affiliates,” “payors,” “network products,” “participating plans,” or “assignment.” A practice can therefore have contractual exposure to downstream payers without signing a separate agreement with each one.

The payer-access list changed after signature

Some network agreements permit an evolving client list. Claritev makes its current payer lists available through its provider portal, while HealthSmart makes current payer and product lists available to participating providers. A contract that looked narrow when signed can become economically broader as new clients gain access.

The agreement followed a TIN, group, or ownership transaction

Acquisitions, tax-ID changes, provider moves, and group reorganizations can leave participation attached to a different entity or location than the operating team expects. The first task is therefore not simply asking whether a clinician is “in PHCS.” It is determining which TIN, NPI, location, contract holder, and effective dates are involved.

The network name was not prominent on the insurance card

The insurer or TPA normally receives more attention than a small network logo. Claritev requires an authorized network name or logo on applicable ID cards and EOBs. HealthSmart notes that some of its products may instead be identified on the EOB or explanation of payment, so the card alone is not a complete audit source.

How a leased network changes what the practice gets paid

The network contract supplies an allowed amount or discount methodology. The payer or administrator then applies patient responsibility, benefit rules, coding edits, and other adjustments before issuing payment.

Electronic remittance advice separates contractual obligations from patient responsibility and supplies reason codes for adjustments. For example, CO identifies a contractual obligation, while CARC 45 can indicate that a charge exceeds a fee schedule, maximum allowable amount, or contracted or legislated fee arrangement. CARC 45 does not identify the contract by itself, so it must be paired with the payer, network, pricing sheet, and executed agreement. CMS remittance guidance explains how ERAs report these adjustments.

The economic test is rate plus steerage

A low contracted rate can still make sense if the network directs enough commercially valuable volume to the practice. A broad discount with little measurable patient steerage is harder to justify. Buyers should evaluate each network using four variables: claim volume, allowed amount by high-volume CPT code, administrative burden, and whether the access replaces better direct-contract opportunities.

What a silent PPO is—and what it is not

A silent PPO applies a provider discount without a valid contractual access path or without required authorization, identification, or disclosure. The critical issue is not that the practice failed to recognize the payer’s name. It is that the party taking the discount cannot connect the claim to an enforceable contract granting access to that rate.

An unexpected leased-network payment is not automatically a silent PPO. A broad third-party-access clause may have authorized the discount even if the current billing team did not know the clause existed. The audit must distinguish poor internal contract visibility from genuinely unauthorized discounting.

State requirements differ. For example, Florida law requires network-rental access to be expressly authorized in the provider contract. The NCOIL Rental Network Contract Arrangements Model Act treats knowingly using a discount without a contractual relationship as an unfair insurance practice and provides a framework for identifying downstream access. The model is not automatically the law in every state.

Before refusing a write-off, rebilling a patient, or escalating a contested discount, obtain the complete contract chain and have the applicable state law reviewed. A payment dispute can involve continuity-of-care, balance-billing, and contract-survival obligations beyond the disputed rate.

How to find every network accessing your contracts

The reliable method is a contract-to-claim audit. Provider directories alone cannot show which downstream payer used a rate on a specific claim.

1. Inventory contracts by legal entity. List every executed payer, PPO, IPA, CIN, management-company, and network agreement. Record the contract holder, TINs, NPIs, locations, products, fee schedules, effective dates, renewal terms, and termination provisions.

2. Search for access language. Review the agreement and incorporated manuals for “lease,” “rent,” “third party,” “affiliate,” “client,” “user,” “payor,” “network product,” “assignment,” and “downstream.”

3. Request current client and payer lists. Claritev provides PHCS and MultiPlan client lists through its provider portal. HealthSmart participating providers can request current payer lists. First Health’s provider resources support participation verification, claim research, pricing sheets, and payer information.

4. Pull a representative remit sample. Review at least several months of 835 files, EOBs, and EOPs across each TIN. Include paid, denied, adjusted, and low-allowed claims rather than looking only at obvious underpayments.

5. Capture every entity on the claim. Record the insurer, plan, TPA, clearinghouse payer ID, repricer, network name, adjustment codes, submitted charge, allowed amount, patient responsibility, and payment.

6. Match the rate to a contract. Ask the payer or network for the pricing sheet and the exact agreement authorizing the discount. “The provider is in our system” is not a complete answer; the response should identify the applicable TIN, network, contract, fee schedule, and date of service.

7. Build an access matrix. Create one row per network and downstream payer showing the contractual path, affected entities, claim volume, effective reimbursement, renewal date, and opt-out route.

How to get out of a rental or leased network

Start with the executed agreement, not a generic cancellation letter. Some contracts allow termination of the entire network only; others contain product-level or third-party-access choices. A practice should not assume it can remove one downstream payer while retaining every other client.

1. Decide what you are trying to terminate

• The entire network agreement.

• One network product under a broader agreement.

• Third-party or downstream access while preserving a direct payer relationship.

• Participation for one TIN, provider, location, or acquired entity.

• An unauthorized discount rather than an otherwise valid contract.

2. Follow the network-specific path

3. Make the notice operationally complete

A termination notice should identify the contract holder, agreement, network products, TINs, NPIs, service locations, requested effective date, and the person authorized to act for the organization. Request written confirmation that provider directories and downstream client files will be updated.

4. Audit claims after the effective date

Do not close the project when the termination letter is accepted. Monitor dates of service after the confirmed effective date, identify any continued discounting, and preserve the contract, confirmation, remits, call references, and correspondence needed for a dispute. Claims for earlier dates of service may remain governed by the former agreement.

When Arctic Health is relevant

Arctic Health’s payer contracting work is relevant when the problem extends beyond cancelling one known agreement. That includes organizations that cannot connect payers to their underlying contracts, have multiple TINs or acquired entities, need to compare rental-network economics with direct contracts, or suspect that systematic payment variances are being hidden inside contractual adjustments.

Arctic Health can combine contract and fee-schedule review with payer-access mapping, remittance analysis, direct contracting, and ongoing payer maintenance. That model is a stronger fit for an RCM or compliance team that needs the relationship corrected and monitored—not merely a legal interpretation of one clause.

Arctic Health is not the right substitute for legal counsel when the central issue is whether a contested discount violates a specific state law or supports litigation. It is also unnecessary when a practice has one clearly documented network agreement, clean claim data, and an experienced internal contracting team able to complete the termination and follow-up.

Frequently asked questions

How do I find out which networks are renting or leasing my contract?

Build a list from both sides of the relationship: executed contracts and paid claims. Request downstream client lists from each network, then search 835 files, EOBs, and EOPs for network names, repricers, unfamiliar TPAs, pricing references, and contractual adjustments. For every suspected access path, require the payer or network to identify the applicable contract, TIN, product, fee schedule, and date of service. Claritev makes PHCS and MultiPlan client lists available through its provider portal.

How do I get out of a leased network I did not intend to join?

First determine whether the discount came from a valid agreement, a broad third-party-access clause, or an unauthorized access path. If participation is contractually valid, use the agreement’s termination or opt-out procedure and obtain written confirmation of the effective date and affected entities. If no contractual basis can be produced, dispute the discount rather than treating the matter as an ordinary voluntary termination. State network-rental laws and balance-billing rules should be reviewed before changing patient balances.

Is it worth joining PHCS?

PHCS is worth considering when its actual patient access and claim volume justify the contracted rates. Before joining, request the fee schedule, current client list, covered products, third-party-access language, amendment rights, and termination terms. Model expected revenue using the CPT codes your practice performs most often rather than evaluating only the headline discount. PHCS is harder to justify when the rate is materially below direct contracts and the network cannot demonstrate useful patient steerage.

Is First Health Network worth joining?

First Health can be useful for practices that want access to self-funded employers, third-party administrators, student plans, trusts, and other groups that do not arrive through a direct carrier contract. The decision should turn on local utilization and effective reimbursement, not the network’s national size. First Health provides claim research, pricing sheets, payer information, fee-schedule requests, and participation verification through the resources listed in the Aetna provider manual.

MultiPlan is now Claritev—should I still be in the PHCS network?

The corporate rebrand does not answer whether PHCS remains economically useful for your practice. MultiPlan Corporation became Claritev Corporation on February 17, 2025, while PHCS and MultiPlan continue as distinct network brands. Review current PHCS client access, claim volume, allowed amounts, and direct-contract alternatives before staying or terminating. The right decision depends on what the network produces under your TIN, not the parent company’s name. The change is documented in the Claritev rebrand announcement.

What should I check before signing my first commercial payer contract?

Check more than the fee schedule. Identify every product and legal entity covered, whether the contract authorizes leasing or downstream access, how third-party payer lists are disclosed, which manuals are incorporated, how rates can change, and whether individual products can be declined. Also review effective dates, timely filing, recoupment, amendment, renewal, and termination provisions. A favorable rate can lose much of its value if the contract permits broad access on terms the practice did not model.

References

• American Medical Association — Fair contracting and rental networks

• Claritev — Provider support, client lists, network brands, and termination

• Claritev — MultiPlan corporate rebrand announcement

• Aetna — 2026 provider manual covering First Health and Cofinity

• HealthSmart — Provider manual

• Centers for Medicare & Medicaid Services — Payment and remittance advice

• Florida Legislature — Network rental statute

• NCOIL — Rental Network Contract Arrangements Model Act

• Three Rivers Provider Network — Network overview

• Arctic Health — Payer contracting and rate negotiation services