Q. What is WPPA ProviDRs Care Network?
A. WPPA ProviDRs Care Network is the only physician-owned Preferred Provider
Organization in
the region.
Q. What does WPPA stand for?
A. When first created, this PPO was named Wichita Preferred
Provider Association. As the company expanded statewide and beyond, the emphasis
on Wichita was dropped. Recently, the name "ProviDRs Care Network" was developed
to better communicate the company's purpose and services.
Q. What is a PPO (Preferred Provider Organization)?
A. A PPO is a medical insurance plan allowing members to receive more coverage at a lower cost if they choose health care providers affiliated with the plan. A PPO builds a network of doctors, hospitals and other health care
providers who agree to accept lower fees from the insurer for their services.
Q. Is WPPA ProviDRs Care Network my insurance?
A. No, we are not an insurance company. We are the PPO
network.
BENEFITS/ELIGIBILITY/INSURANCE
Q. What are the benefits of using ProviDRs
Care Network?A. Our providers and facilities deliver the
maximum benefits of your insurance plan and are continually reviewed to maintain
the highest quality care. ProviDRs Care Network conducts its own Utilization
Review for many plans, using health care professionals to determine the appropriateness
of proposed medical care. This review service leads to cost-effective and
quality health care services.
Q. If ProviDRs Care Network can't verify
patient eligibility, then where do I call to verify benefits? A. The Insurance company or payor assists with questions
regarding insurance benefits, patient eligibility, or claim payment status.
Q. Where do member ID cards come from?
A. The member ID card is formatted and issued by the
insurance company or payor.
Q. Where do I go for an emergency if I'm going
on vacation in another state?
A. Contact your insurance company. They may have another
PPO network in place in other states.
Q. How do I know if a physician or facility is
in the ProviDRs Care Network?
A. This information is available on our website. Click here to access our online
provider directories. You may also verify participation
by calling Provider Relations at (316) 683-4111 or (800) 801-9772.
Q. Is pre-certification required? What number
do I call for pre-certification? A. Pre-certification information is found on the ID card along
with the number to call for pre-certification.
Q. Group name and number are required on claims,
why?
A. ProviDRs Care Network often has no control over the policy
numbers assigned. Therefore, duplicate numbers can appear on a claim.
When the group name is supplied on the claim along with the policy number, we are
able to process your claim under the correct policy/group. This ensures
that the claim is delivered to the correct administrator for payment. When
the group name is not given on a claim that is filed with a duplicate policy number,
the claim is returned to the provider for this information, creating unneccessary
delay.
Q. Is there a guideline of employer groups and
employer group numbers?
A. Yes, ProviDRs Care Network publishes a listing of all the
groups accessing the network. For an updated report, contact a Provider Relations
representative at (316) 683-4111.
CLAIMS/REPRICING
Q. How long does a provider or facility have to
file a claim?
A. 90 days from the last day of the month in which the services
were rendered.
Q. Where are claims processed?
A. Refer to the patient's ID card for the correct claims filing
address.
Q. What is the claim repricing turn-around time?
A. The average is 3 days.
Q. Is a ProviDRs Care Network member entitled to
receive the PPO write-off for non-covered services?
A. Allowables and write-offs are only applicable to covered
services. Participating providers are not required to take a write-off on
non-covered services.
Q. How are claims sent to ProviDRs Care Network?
A. By regular mail, fax or electronically. The ProviDRs
Care Network in conjunction with Legacy's AdminisTEP offers electronic submission
of claims for providers and groups. For information, call Legacy AdminsTEP's
EDI Coordinator at (888) 751-3271 ext 3141 or visit their website at www.adminsTEP.com. The mailing
address for paper submissions is 1102 S Hillside, Wichita KS 67211 and the fax number
for claims is (316) 683-1271.
Q. How are providers notified about claims that
cannot be repriced?
A. These claims will be returned in the same manner in which
they were submitted to ProviDRs Care Network. A "PEP", Provider Education
Program, representative may contact the provider for training or assistance on claims
filing.
Q. What do I do if I think my claim repricing/payment
was wrong? Can I appeal a claim?
A. You can appeal to ProviDRs Care Network by mailing or faxing
all relevant information, including the claim and EOB (Explanation of Benefits)
to:
WPPA ProviDRs Care Network
Attn: Appeals
1102 S. Hillside
Wichita KS 67211
or Fax to (316) 683-1271
CREDENTIALING
Q. Are providers credentialed and how often?
A. Yes, the process of credentialing and recredentialing,
which is verifying and re-verifying plus updating provider's credentials.
The re-credentialing takes place every two years. The re-credentialing anniversary
is determined by the provider's birth month and year.
Q. Is the credentialing process long?
A. The ProviDRs Care Network's credentialing is typically
completed within 4-6 weeks if the application is correctly completed.
