Adminstrative Services

Preferred Choices PPO will provide the following services when you access our leased network.

• Maintenance of the provider network; maintenance of fee screens, contracting and credentialing, provider notification and updates, routine servicing and complaint resolution between provider, employer and TPA.
• Receive and pre-price all clean network claims and forward to TPA/insurance company within four business days from receipt. Original claim and Preferred Choices PPO pre-price cover sheet will be sent to TPA/insurance company. Submitted claims will be checked for DRG validation, accuracy and completeness before submissions to TPA/insurance company.
• Provide the Preferred Choices PPO logo and Quality Management information for ID cards to ensure provider recognition.
• Access to 800 number to Member Services department for questions on provider network.
• Routine employer utilization reports.
• Routine updates to TPA/insurance company via vendor tape (Provider Network).
• Provide a copy of the Preferred Choices PPO Provider Directory for every employee and maintenance of Web page database.
• Availability of limited consulting services upon request of the TPA and/or client.
• Routine sales servicing for TPA and client, including assistance with on-site employee meetings