ServiceXG Basics

Link a member or dependent to PPO

If a plan has multiple PPO A group of providers who contract with employers, insurers or administrators to provide services to individuals for a negotiated amount. options and requires a member to select a PPO, use this option to enter that information.

The PPO selection can also be stored at the dependent level. If the claim is outside the PPO the member chose and, the claim is considered an out-of-network claim even if the provider belongs to another PPO in the system.

1. If the member isn't already associated with a PPO, a message shows at the bottom of the screen asking if you want to create an association. Enter Y.
2. Enter the From and Thru Dates.
3. Enter the PPO. Valid values are
   • UHC—United Health Care
   • AL—Alliance PPO
   • AETNA—AETNA In-Network
   • AETNON—AETNA Out Of Network
   • INT—Internal PPO
4. If you're entering information on only one PPO for the member, type 1 to indicate that this is the member's primary PPO association.
   • Enter 2 or 3 if this is the member's second or third PPO association.
5. At the select line, type F.

SEE ALSO