What is PPO USA Network? PPO USA Network is a network of Participating Providers that includes physicians, provider groups, hospitals and facilities, all of which have contractually agreed to a method of reimbursement. Types of reimbursement include physician fee schedules, facility fee schedules and per diem rates. PPO USA Network Participating Providers agree to discount their services and not balance bill members in exchange for payors agreeing to direct their members to Participating Providers and to promptly pay claims. GEHA is currently the only payor using the PPO USA Network. What is Government Employees Health Association, Inc. (GEHA)? Is it an HMO? GEHA is a not-for-profit association that provides health care benefits to federal employees, federal retirees and their families. GEHA is the third largest insurance plan in the federal employee marketplace. GEHA is not an HMO. Rather, GEHA is a fee-for-service plan with a built-in PPO option. Members who choose to visit PPO providers for their health care needs will be rewarded a higher level of benefits. GEHA owns and operates the PPO USA Network. How do I benefit from joining your network? When you join PPO USA Network, we: Actively direct insured patients to PPO USA Network Participating Providers by way of financial incentives and other benefit differentials. List Participating Providers in printed directories and on our website directories, and provide telephone referrals to our members. Ensure 30-day reimbursement on clean claims. Provide you with dedicated Provider Relations Specialists to assist you and answer questions. Offer you efficient online service through PPO USA Network's website at www.ppousanetwork.com. If you ever lease the network to other payors, how will their insured lives be directed to me? Your name and practice information will be included in their directories. Other payors' customer service departments will direct insured members to PPO USA Network Participating Providers. Insured members can search for Participating Providers on our payors' websites. Other payors' identification cards will contain the PPO USA Network logo. Will there be incentives for other payors' insured members to choose me? Yes. Our payors will pay a higher level of benefits to PPO USA Network Participating Providers. Other payors' members may pay a lower copayment and have less out-of-pocket costs when they select a Participating Provider. How did you derive your fee schedule? The majority of PPO USA Network's fee schedules are based on a percentage of Medicare's RBRVS. What if a CPT code is not listed on the fee schedule I received? The fee schedule included in the application packet lists the top 350 most frequently used codes. Contact our office at (800) 821-4991, Option 2, to obtain fee schedule amounts for CPT codes not listed or fax your request to (816) 434-4433. Please be sure to include your name, telephone number, city and state on your faxed request. What am I obligated to write off? Your write-off will be the difference between the fee schedule amount and your regular charge. If your regular charge is less, there is no write-off. There are several doctors in our group. Can I just send their names on a list to enroll them? No. Each individual medical provider must complete a Provider Application and sign an individual Participating Provider Agreement unless your group has 30 or more providers and performs its own credentialing. I am a Participating Provider with PPO USA Network through a group agreement. However, I am not sure the physician group with whom I practice will continue. Can I transfer my group participation into an individual agreement? No. If the physician group with whom you practice disbands, in order to remain a PPO USA Network Participating Provider, an individual Participating Provider Agreement and Provider Application will need to be completed. If you are unsure about the status of your group agreement, please contact our Provider Relations Department at (800) 821-4991, Option 4. Can I participate as a PPO USA Network Participating Provider and not accept new patients? Yes. Participating Providers are not required to accept new patients. Simply notify our Provider Relations Department at (800) 821-4991, Option 4, that your office capacity is full, and we will make the necessary notation in our system. Once this is done, we will not refer new patients to your office until further notice is given. How often will I be recredentialed? Recredentialing is performed every 36 months. Our Credentialing Department will notify you when it needs updated information. Are there any costs associated with participating in the PPO USA Network? No. PPO USA Network is an open network with free participation. We encourage you to sign up today!