Network Management

A growing network

PHN delivers an ever-expanding network of qualified providers and medical experts offering patients the freedom to choose a physician that best meets their health care needs.

Local service

Prevea Health Network negotiates directly with the providers in its network. Direct contracting ensures fair treatment of providers, and seamless network access for patients.

Provider qualifications

A quality network begins with quality providers. All physicians, providers, and medical facilities are held to the highest standards developed by national credentialing, accrediting, and certifying organizations.
 

Relationship building

Prevea Health Network has systems in place to simplify processes and foster relationship building between provider and patient. We act as a provider advocate, when necessary, to achieve prompt claim reimbursement. 

Payor Services

Prevea Health Network has contracted with a variety of payors that offer a number of health care programs under a variety of insurance arrangements.

• Fully insured plans
• Self insured plans
• Direct employer contracts
• Employer coalitions
• Regional PPO Networks

It is the patient's responsibility to verify each provider's participation in the Prevea Health Network prior to seeking care. However, to ensure that you receive proper payment for the care you deliver, everyone in your practice should routinely use the following procedures:

1. Check the patient's ID card and call the insurance carrier or claims administrator to verify eligibility. PHN does not verify eligibility.
2. Submit patient claims to the address listed on the patient's ID card.
3. Always include the PHN payor name on your claim form.
4. Only collect co-payments, deductibles, coinsurance and/or non-covered expenses from patients. Do not collect the amount due from the insurance plan or the PHN discount amount (i.e. the difference between your billed charges and the PHN contracted reimbursement).
5. Whenever possible, refer patients needing specialty physician services, hospitalization, x-rays, lab work or other services to a PHN participating health care provider. Visit the PHN website at www.preveappo.com or call PHN directly to verify the provider's network status. The toll-free number is 1-866-640-7444.
6. If a patient requires surgery or hospitalization make sure you know whether pre-certification is required. This information is listed on the patient's ID card.
7. Before any schedule admission, or at the time of an emergency admission, call the review organization listed on the patient's ID card.