GEHA's goal is to provide excellence in service to our PPO USA Network Participating Providers. Below are important numbers and links for you.

Patient self-referral
GEHA members have the luxury of choosing their own physicians and other health care providers without needing referrals. However, to ensure members obtain the highest level of benefits, it would be helpful to refer them to other PPO USA Network Providers. To find other Participating Providers in your area, go to the Provider Search at www.geha.com or call (800) 821-6136.

GEHA benefit information
To find out about your claims status, verify patient eligibility or confirm covered services for GEHA health plan members, call (800) 821-6136 or go to www.geha.com and select Provider Web Services. You can view 18 months of GEHA claims data.

GEHA claims submission
You may submit paper claims to the address on the back of the patient's ID card or submit electronic claims through your electronic clearinghouse vendor.

• GEHAs Payor ID is 57254.
• GEHA claims appeals should be sent to the address on the back of the ID card.

URAC Accreditation
Our PPO USA Network continues to maintain its Network Accreditation status through URAC. To find out more about our network’s minimum professional requirements, credentialing or recredentialing criteria or network appeals processes, please see our Provider Manual.

• Click here and go to page 7 to find out more about our minimum professional requirements.
• Click here and go to pages 9-14 to find out more about our credentialing and recredentialing critiera.
• Click here and go to page 35 to find out more about our network appeals processes.

Credentialing
We recently began using a Credentials Verification Organization for the primary source verification of our providers’ credentialing documents and started monitoring provider credentials on an ongoing basis. We will have a three-year phase-in period for our new credentialing processes, which will include performing site visits for contracting parties to whom we have delegated the credentialing process.

• To view our updated credentialing legal policies and procedures, click here.
• To find out more about your credentialing rights, click here.
• Keep in mind that once you are accepted into the network, you will continue to participate unless you are notified otherwise.

Provider data integrity
In preparation for a system conversion in 2011, we have been sending demographic reports to our contracted providers and asking them to verify the accuracy of our provider data. Participating Providers are also contractually required to submit the following information to us:

• Adverse changes in Licensure or Board Certification status
• Loss of eligibility in the Medicare or Medicaid programs
• Decreases or losses in general liability or malpractice insurance
• Any finding of guilt in a criminal prosecution or for any felony related to the medical profession
• Changes in status, such as new employment or retirement
• Any changes of name, address, telephone number or Tax Identification Number

• To check your demographic information, click here.



• To send us your updated information, fax it to (816) 257-4437, email it to us at ProviderRelations3@geha.com or click here .

GEHA's new line of business
GEHA was recently selected to administer the Pre-Existing Condition Insurance Plan (PCIP) on behalf of the U.S. government in more than 20 states. The PCIP was created by the Affordable Care Act to help provide coverage to uninsured people with pre-existing conditions until new insurance market rules go into effect in 2014. The following PPO USA Network states are also being used by GEHA to provide an in-network PPO option to members of the PCIP:

• To find out more about the PCIP, click here.

Service area changes
At the end of 2010 GEHA decided to cease operating the PPO USA Network in Colorado, Oklahoma and Utah. Beginning January 1, 2011, GEHA entered into a shared service arrangement with UnitedHealthcare to offer its members in Colorado, Oklahoma and Utah a preferred provider network called UnitedHealthcare Options PPO Network. If you are located in one of these three states and are interested in continuing your preferred provider status with GEHA, please call UnitedHealthcare at (877) 842-3210 to request a participation packet.

Network services
Our PPO USA Network representatives are available to answer your questions. Call us at (800) 821-4991, Option 2, or send us your questions by fax at (816) 257-4437, by email at ProviderRelations3@geha.com, or in writing to: