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Payer Frequently Asked Questions (FAQs)

  • Describe the background of the company.

    PPOplus is the region’s premier PPO with comprehensive networks in Louisiana, Mississippi and Arkansas and with nationwide coverage offered to its membership.

    Originally built by leading regional community hospitals in 1988, PPOplus is today, an independent PPO, not owned by providers or insurance carriers.

    PPOplus’ network is made up of over 30,000 established medical providers throughout Louisiana, Mississippi and Arkansas. In order to provide a consistently high level of patient choice, PPOplus maintains an open panel provider network. This means that physicians or other healthcare providers that meet the credentialing requirements and criteria established by PPOplus are eligible for participation in our network.

  • What services are currently offered by PPOplus?

    PPOplus offers comprehensive provider networks in Louisiana, Mississippi and Arkansas. PPOplus also provides nationwide coverage to its membership through direct management and access of a nationwide network. Access to our networks is offered on a state-by-state basis. In addition to providing network access, PPOplus offers claims repricing and data management services, on demand training and education, and toll free customer support lines.

  • Are we required to utilize all of the services offered by PPOplus?

    No, these services can be purchased in whole or in part based upon each client’s needs.

  • Does PPOplus have EDI capabilities for electronic claims submission?

    Yes, PPOplus has become known as an industry leader in receiving, repricing and returning claims electronically.

    The benefits of electronic claims submission include speed of submission and repricing of claims, minimized errors and omissions, elimination of double entry of claims data by both the PPO and the payer, reduction in the number of rejected claims and expedition of claims payment.

  • How do we get new providers added to PPOplus’ network for our clients?

    As a Payer or Agent / Broker the best way to get providers added to PPOplus’ network is to email the names and addresses of the physicians or other healthcare providers that you want added to: ProviderContact@Zelis.com.

    Marketing will work with our Provider Services Department to recruit the providers that you requested and we will keep you apprised of the status of those recruitment efforts.

    Remember, we can be more successful in our recruitment efforts if you provide us with information on the name of the group requesting the provider and where the group is located.

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