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To view these applications, you need the Acrobat Reader program. If you do not have
Acrobat Reader, please click on the link provided below. The link will take you to the
Acrobat website and allow you to download Acrobat Reader free of charge. |
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Download Adobe Acrobat Reader |
Thank you for your interest in the PPO USA Network. We have three types of Applications:
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PPO USA Provider Application — This Application is to be used by all
individual providers. If a question is not applicable to you, please write
"N/A" on the document or leave the answer blank. Click to download
a copy of the Application.
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PPO USA Hospital Application — This Application is to be used by
hospitals only. Click to download a copy of the Application.
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PPO USA Facility Application — This Application is to be used by all
ancillary providers that are not hospitals or individual providers. Click to download
a copy of the Application.
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Each Application must be submitted
with a signed and completed Participating Provider Agreement. To request a Participating
Provider Agreement from one of our professional contract negotiators, go to
contact us. Please keep in mind we have different
types of Agreements, depending on your provider type and the number of physicians in your
office. To find out more about which type of contract you will need to join the PPO USA
Network, click here.
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