The network consists of 3 affiliated provider owned networks covering Ohio including: The Ohio State University Health Plan, Ohio Health Choice – Preferred Health Choice Plus, Quality Care Partners – Plus.
No. You only need to participate with one of the three networks to be considered in-network. However, if you share a contracted Tax ID with other providers, you’ll want to verify your participation by performing a provider search from the main page. The network through which your contract is participating will show on the search results to the right of the provider name.
Select one of the search options from the “Providers” section of the main Ohio PPO Connect home page. By performing a search, the results will show the logo of the network through which you are participating in Ohio PPO Connect. You may also contact the network through which you are participating directly to obtain a confirmation of participation if you contract using multiple Tax IDs.
Ohio PPO Connect is not an administrator of the member’s benefits and does not pay claims or determine eligibility. You will need to refer to the member’s ID card to identify the administrator of the member’s benefit plan and direct inquiries to the phone number listed on the card.
The ID card is the first place to reference to gain an understanding of the member’s network and coverage. It’s important to read the card to determine the network in place as Ohio PPO Connect may be the primary or the wrap network depending upon the member’s benefit plan, tiered network access and the provider location. If you are having a difficult time interpreting the card, always contact the administrator listed on the card to obtain clarification.
You must submit the claim to the claims address listed on the member’s ID card. Depending upon the employer’s benefit plan, Ohio PPO Connect may be the primary or the wrap network. Therefore, claims have to be submitted as directed on the ID card to ensure seamless and expedited processing.
There can be several points of contact to determine claim status. Claims that go to Ohio PPO Connect for repricing go through a single hub called Claims Bridge. Claims Bridge will direct the claim to the appropriate network partner to be repriced and will send the repriced claim to the administrator for adjudication. Therefore, if you have questions on an adjudicated claim as it pertains to benefits or eligibility, you’ll want to contact the administrator on the ID card. If you have a question as to the status of the repricing process, you may contact Claims Bridge directly at (410) 349-3222 or download the inquiry form here, or you may contact the network through which you are participating directly for assistance. Claims Bridge also offers an online claim lookup feature if you request an account with them. Questions with regards to contracted rates must be directed to the network through which you are participating.