Q: 1. What is OneNet PPO?

OneNet PPO is a comprehensive network of physicians, health care facilities, hospitals, and health care practitioners. Payers lease the OneNet PPO network for their members, to obtain a quality health care network that allows members to choose their health care practitioners and facilities within their preferred geographic area.

Q: 2. What is an OneNet PPO Payer?

An OneNet PPO Payer is an insurance carrier, union fund or self-funded group that contracts with the OneNet PPO Preferred Provider Network for the provision of health care services to their members. Payers may lease the OneNet PPO network by itself or in combination with its sister products, OneNet PPO Utilization Management and MAPSI (a behavioral health network), or its ancillary products which include Discount Dental, Dental PPO and Workers’ Compensation.

Q: 3. What is an OneNet PPO Participant?

An OneNet PPO participant is an insured employee or a dependent of a member of an employer group health care plan that has contracted to lease the OneNet PPO Preferred Provider Network for the provision of discounted health care services. The employer or group-sponsored health care plans may be provided by self-funded or fully insured employer groups and union funds.

Q: 4. Does OneNet PPO pay claims?

No, OneNet PPO does not pay claims. OneNet PPO reprices participating network claims submitted by participating health care practitioners and applies the appropriate discount or fee for service. The repriced claims are then submitted to the applicable payer (insurance carrier, third party administrators or union fund) for payment. OneNet PPO payers retain fiduciary responsibility for the funding of claims and administering the health care benefits of the applicable health care plan. OneNet PPO does provide (EDI) electronic data interchange services. You may contact our professional services department to obtain additional information.
Please submit to:

1. OneNet PPO Claims
P.O. Box 934
Frederick, MD 21705-0934

2. OneNet PPO FELRA Claims
P.O. Box 936
Frederick, MD 21705-0936

3. OneNet Workers Comp Claims
P.O. Box 939,
Frederick, MD 21705-0939

4. OneNet PPO/GEHA Claims
P.O. Box 938
Frederick, MD 21705-0938

5. Multiplan Claims
P.O. Box 6497
Rockville, MD 20849

OneNet PPO does not maintain any eligibility or benefit information. This information must be obtained from the payer.

Q: 5. When is the OneNet PPO Professional Services Department available?

The OneNet PPO Professional Services Department is available 24 hours a day, 7 days a week, 365 days a year at 1-800-342-6141 to assist with all health care professional issues, including obtaining repricing sheets, claims repricing status and other network-related issues.

Q: 6. How do I obtain an OneNet PPO Provider Directory?

Click here to create a customized Directory of Health Care Professionals online or call our Professional Services Department at 1-800-342-6141 to request a customized directory.

Q: 7. How do I become a participating health care practitioner in the OneNet PPO Network?

OneNet PPO welcomes the opportunity to work with all qualified healt hcare practitioners within the mid-Atlantic region. To learn more about joining our network, call our Professional Services Department at 1-800-342-6141.