PPO USA Network Overview

We've been working hard to recruit new providers, improve our network's quality and efficiency, and ensure members are being directed to our Participating Providers. Here are some network highlights:

• We have been preparing for a system conversion by reviewing all provider directory data for consistency and accuracy. In 2010 we will be doing a full audit of all group agreement rosters to ensure the provider data is accurate.



• Our credentialing process is moving toward URAC accreditation, and we are gearing up to start performing site visits of our delegated credentialing entities.



• To help ease the amount of paperwork providers must submit and to simplify our initial and recredentialing processes, we will begin primary source verifying as much credentialing information as we can in the near future.



• In an effort to maintain the most up-to-date provider information, we will be establishing an ongoing provider monitoring system so we can review providers’ professional credentials to ensure there are no adverse changes between our credentialing cycles.



• We will implement new credentialing requirements for hospitals, surgery centers (including birthing centers), home health facilities and skilled nursing facilities.



• To ensure all provider types are represented on our Peer Review Committee, we added a General Surgeon and an Anesthesiologist.



• We recently sent contract notices about GEHA’s change in precertification vendor from ENCOMPASS to InforMed Medical Management Services and the addition of GEHA’s Never Event policy to all providers in Colorado. Both of these changes were effective January 1, 2010.



• And finally, we continue to update network documents and implement new policies and procedures in an ongoing effort to maintain compliance with all applicable state laws and regulations that affect non-risk bearing PPO networks like PPO USA Network.