1. What is PPO USA Network?
    2.

    PPO USA Network is a non-risk bearing PPO network that is owned and operated by GEHA. Our Participating Providers include physicians, groups, hospitals and facilities, all of which have contractually agreed to accept a fee schedule or rate schedule as payment in full for Covered Services.

    PPO USA Network Participating Providers agree accept a discount and not balance bill members in exchange for GEHA agreeing to give Participating Providers directed business and promptly pay claims.

  2. What is Government Employees Health Association, Inc. (GEHA)?
    Is it an HMO?

    3. GEHA is not an HMO. GEHA is a not-for-profit membership association that provides health care benefits to federal employees, federal retirees and their families. GEHA has the second largest medical insurance plan in the federal employee health care program. GEHA is a fee-for-service plan with a built-in PPO option. Members who choose to visit in-network providers for their health care needs will be rewarded a higher level of benefits.

  3. How do I benefit from joining your network?

    4. When you join PPO USA Network, we:

    • actively direct GEHA members to PPO USA Network Participating Providers by way of financial incentives and other benefit differentials.
    • list Participating Providers in online directories and provide telephone referrals and printed directories to our members.
    • ensure 30-day reimbursement on clean claims.
    • provide you with dedicated Provider Relations Specialists to assist you and answer questions.
    • apprise you of network activities through PPO USA Network's website at www.ppousanetwork.com.

  4. Do you still lease the PPO USA Network to other payors?

    5. GEHA has recently made the decision to stop leasing the PPO USA Network to other payors. The only medical payor still leasing the PPO USA Network at this time is Time Insurance Company d/b/a Assurant Health, and our relationship will be winding down in 2011. Assurant Health leases the PPO USA Network in the States of Alaska, North Dakota and Wyoming. Assurant Health’s members have financial incentives to choose PPO USA Network Participating providers. If an Assurant Health member presents for services, be sure to check the identification card for the PPO USA Network logo, and Assurant Health’s customer service phone number and claims address.
  5. How did you derive your fee schedule?

    6. The majority of PPO USA Network's fee schedules are based on a percentage of Medicare's RBRVS.

  6. What if a CPT code is not listed on the fee schedule I received?

    7. The fee schedule included in the solicitation 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.

  7. What am I obligated to write off?

    8. Your write-off will be the difference between the fee schedule amount and your regular charge. If your regular charge is less that the fee schedule amount, there is no write-off.

  8. There are several doctors in our group. Can I just send their names on a list to enroll them?

    9. 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.

  9. 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 participating. Can I transfer my network participation from a group agreement to an individual agreement?

    10. No. If the physician group with whom you practice terminates their contract with GEHA, you must complete a Provider Application and individual contract in order to remain a PPO USA Network Participating Provider. If you are unsure about the status of your group agreement, please contact our Provider Relations Department at (800) 821-4991, Option 2.

  10. Can I participate as a PPO USA Network Participating Provider and not accept new patients?

    11. Yes. Participating Providers are not required to accept new patients. Simply notify our Provider Relations Department at (800) 821-4991, Option 2, that your office capacity is full, and we will update in our system. Once this is done, you will no longer be listed in our directories.
  11. How often will I be recredentialed?

    12. Recredentialing is performed every 3 years. Our credentials verification organization, VerifPoint, will notify you when we need updated information.
  12. Are there any costs associated with participating in the PPO USA Network?

    13. No. PPO USA Network is an open network with free participation. We encourage you to sign up today!