PPO USA Network Overview

2008 has been another busy year for our network. Our staff worked hard to ensure that we’re compliant with new laws and regulations that continue to be passed in many states. We sent Summary Disclosure Form notices to all individually contracted Colorado providers over the summer, and by the end of the year we will send the remaining required notices.

We have hired additional Provider Relations staff members to answer your questions and provide you with network materials. We also recently reassigned the network states in our Provider Relations department, so you may be working with someone new the next time you call us. We continue to implement new processes to increase efficiency in our Provider Relations department, including speeding up data entry, reviewing verification reports for quality assurance purposes and streamlining workflow.

We are wrapping up our Tulsa County, Oklahoma, recruitment right now. We recently sent solicitation packets to all Tulsa County providers who are participating in our network through a large Oklahoma corporation contract that terminates on December 31, 2008. Providers who are currently participating through the Oklahoma corporation but do not contract directly with GEHA by the end of the year will end their PPO status with GEHA. If you are in Tulsa County and are unsure whether you are contracted directly with GEHA effective January 1, 2009, please call a Network Development representative at (800) 821-4991, Option 1.

We revamped our recredentialing process this year, and so far we’ve received excellent feedback from our providers about the changes. We eliminated our recredentialing application, which means we no longer require our participating providers to complete an application every three years to continue participating in our network. We now only require participating providers to submit supporting documentation that has changed during the previous credentialing cycle. This new process has increased our efficiency and lowered costs for the network, and we hope it has lessened your paperwork.

Another change our credentialing department made this year was to start allowing our participating providers appeals rights prior to terminating them for encumbered licenses. Our appeals procedures allow ample time for participating providers to rectify their license status in order to avoid adverse actions being taken by the network. And finally, our credentialing department continues to modify its internal processes in order to meet state law requirements and timeframes.

During the summer, we increased our member access to care and provider availability in southwestern Colorado. We are currently evaluating our network’s goals and achievements and will continue to try to improve access and availability in rural and other targeted areas through focused recruitments in 2009.