Get Preferred Provider Network (ppn) Survey - Ct.gov

Completing the Preferred Provider Network (PPN) Survey is essential for managed care organizations to provide accurate information to the Insurance Department. This guide offers detailed instructions on each section of the survey to ensure a smooth and efficient online filing process.

Follow the steps to successfully complete the PPN Survey.

1. Press the ‘Get Form’ button to obtain the form and open it for editing.
2. Enter the name of the PPN in the designated field to identify your network.
3. Provide the name of the PPN parent company to establish the organizational structure.
4. Fill in the PPN address accurately, including street, city, state, and ZIP code.
5. Complete the contact information section by providing your name, title, mailing address, phone number, fax number, and email address.
6. Respond to the question about whether your PPN provides services only for workers’ compensation or self-insured arrangements by selecting the appropriate option.
7. If applicable, complete the 'Certification of Accuracy' section by entering your printed name, title, and organization, and signing and dating the document.
8. Indicate the type of PPN by checking the appropriate boxes and providing any necessary explanations.
9. Supply the name and address of any controlling or related companies and explain the relationship with them.
10. Attach any required documents, such as a certificate of good standing, balance sheets, and lists of board members and principal owners.
11. Answer the question regarding any suspension, sanction, or disciplinary action taken against the PPN and provide explanations if necessary.
12. Describe the PPN’s service area, detailing the number of participating hospitals and listing their names.
13. Provide information about participating primary care and specialty physicians, including capacity to accept new patients.
14. Indicate the types of reimbursement arrangements with Managed Care Organizations and list the services offered.
15. Compile all necessary information and ensure that you have filled all sections completely before finalizing the form.
16. Once completed, save changes, download the form, print it, or share it as needed before submission.

Complete the PPN Survey online today to ensure your organization is compliant and up-to-date.