GEHA Federal: Major Transitions and updates in 2025

As a trusted provider, it's crucial to stay informed about changes in insurance processes to ensure smooth operations and optimal care for your patients. Government Employees Health Association (GEHA) has implemented several significant transitions this year, impacting medical and dental claims processing. Here’s a comprehensive overview to help your dental office adapt seamlessly.

1. Benefit Services Outsourced to UMR

GEHA has partnered with United Healthcare’s third-party administrator, UMR, for handling benefit services. This shift centralizes administrative tasks and aligns GEHA’s processes more closely with UMR’s established systems.

2. Updated Payer ID for Claims

The payer ID for submitting medical and dental claims has changed to UMR’s "39026". Ensure that your billing team updates this information in your systems to avoid claim rejections or delays.

3. New Claims Mailing Address

For claims submitted by mail, the updated address is:

P.O. Box 21191, Eagan, MN 55121

Double-check this information on all documentation to prevent processing errors.

4. System and Process Overhaul

GEHA’s system now mirrors UMR’s processes. Key changes include:

• Benefits Inquiry Process: Direct access to insurance representatives is no longer available. Instead, you must first request a faxback to receive limited information.
• Enhanced Access with Passcodes: To obtain additional details, use the passcode provided on the faxback to reach an insurance representative.

Encourage your team to familiarize themselves with this process to minimize disruptions in obtaining patient benefit information.

5. Changes to ID Numbers

Patient ID numbers under GEHA plans now begin with a "G" prefix followed by numbers. Update your records accordingly to ensure accurate patient identification and claims processing.

6. Network Changes Impacting Providers

• Cigna Network Changes: Providers under the Cigna network will no longer be considered in-network for GEHA plans. This transition may result in higher costs for patients due to lower out-of-network benefits.
• Connection Dental Network: To maintain in-network benefits with low costs for patients, dental providers must be contracted with GEHA’s Connection Dental Network. Confirm your network status and take steps to contract with Connection Dental if necessary.

Action Steps for Your Dental Office

To adapt to these changes and support your patients:

1. Update all billing and claims submission information, including payer ID and mailing address.
2. Train your team on the new benefits inquiry process and the use of faxbacks and passcodes.
3. Verify the updated patient ID numbers and ensure proper documentation.
4. Review your network status with GEHA and consider contracting with the Connection Dental Network to remain in-network.
5. Communicate these changes to your patients to manage their expectations regarding coverage and costs.

Conclusion

These transitions reflect GEHA’s efforts to streamline operations and enhance service efficiency. By staying informed and proactive, your dental office can navigate these changes effectively, ensuring uninterrupted care for your patients.

For a hassle-free dental insurance verification solution, join Quicklify Dental to simplify your processes and ensure seamless patient support. Sign up today by visiting www.quicklifydental.com/sign-up.