Q. What are the advantages of Meridian Health Plan (MHP)?
A.
MHP maintains a high quality, comprehensive care management program.
MHP's approach and organizational structure ensures effective linkages across
administrative areas, including Member Services, Provider Support Services,
Network Development, Quality Improvement, Grievance/Complaint management,
Medical Information Systems (MIS), Utilization and Case Management.
Meridian Health Plan's size allows us to have substantial flexibility in our
relationships with providers and hospitals. We believe that practitioners should
have as much freedom as possible to practice medicine. With this goal in mind,
MHP has developed a nearly paperless authorization system, including an online
Managed Care System (MCS) for use by all contracted providers.
MHP provides a wide range of both preventive and therapeutic health care
services to our members. We take great pride in achieving high standards
regarding HEDIS measures, and in implementing technically advanced actions to
ensure its success.
Q. What is MCS?
A.
MHP's innovative Managed Care System (MCS) allows online authorizations
to be viewed, created and authorized by our PCPs, Specialists and Hospitals. In
addition to referrals and authorizations, providers may view specific preventive
health care services needed for their own patients, verify eligibility, and status
claims online. The MCS is a real-time information system available to all
contracted providers free of charge.
Q. How do I join the MHP provider network?
A.
In order to ensure and maintain a high level of medical care, all providers are
credentialed by MHP. Appropriate contracts and applications are provided, along
with a questionnaire regarding office function, personnel and the potential
capacity to service more enrollees. Both MHP and the State of Michigan require
proof of licensure and appropriate malpractice insurance coverage. In the case of
an agreement with a Physician Hospital Organization (PHO) or a Physician
Organization (PO) that has already credentialed member providers, MHP will
consider the option of delegating that responsibility to the PHO/PO.
To receive information on becoming a contracted Provider with Meridian Health Plan, please contact our Provider Services Department by clicking here.
Q. What are my contract options as a health care provider in the MHP network?
A.
Primary Care Providers
MHP contracts with primary care physicians on a fee for service basis, with
quality bonus incentives in lieu of traditional full risk arrangements. This focus on
quality instead of risk allows physicians to do what they do best: treat patients.
Specialist Providers
MHP values the relationship with our Specialist Providers and seeks to limit the
amount of "red tape" whenever possible, especially with referrals and
authorizations. MHP continues to provide prompt claims payment to
Specialist providers: within 10 days or less.
Hospital Providers
Communication is the key to all mutually beneficial relationships. In this regard,
MHP makes every effort to partner with each contracted Hospital in coordinating
the care of its beneficiaries. Hospital providers can count on Meridian Health Plan
to help serve their communities with as little interference as possible.
For more information, see the links below.
Michigan Medicaid Fee Screens
Michigan Medicaid Policy Bulletins
Q. What is the behavioral health benefit for MHP members?
A.
Twenty (20) outpatient visits per calendar year.
Q. Do I need to obtain an initial authorization?
A.
No. MHP provides up to ten (10) outpatient visits without prior notification.
Q. How do I request additional visits after the 10th visit?
A.
MHP requires notification if you anticipate the member will require more than
10 visits for treatment. The notification must include the DSM -IV diagnosis,
reason for continued treatment, and status of PCP notification. Please fax the
completed
MHP Continued Outpatient Treatment Notification form
to 313-202-1268.
Q. Do I need to obtain authorization for psychological testing?
A.
No. Up to 5 hours of testing is permitted using either CPT code 96101 or
96102. The tests and measures must be rendered by full, limited-licensed, or
temporary-limited-licensed psychologists.
Q. What if I have questions regarding a member's eligibility?
A.
All MHP providers can use our secure Provider Web Portal to determine
member eligibility, view claim status, self-report HEDIS measures and much
more at no cost. To learn more about this time-saving service, please call the
MHP Provider Services Department at 888-773-2647. Member eligibility can
also be determined by calling the MHP Member Services Department at
888-437-0606.
Q. Who should I contact if I have questions regarding my Provider affiliation
status or general questions related to MHP?
A.
Please call the MHP Provider Services Department at 888-773-2647.
Q. Can both the Psychiatrist and the Therapist who are engaged in the
same episode of care each bill for a 90801?
A.
No, MHP reimburses for one "Psychiatric diagnostic interview examination"
(CPT Code 90801) per year per provider group.
Q. If a member appears to be suffering from a Severe Mental Illness (SMI)
how do I connect the member to Community Mental Health (CMH)?
A.
Call the MHP Behavioral Care Department at 888-222-8041 to notify us of
your evaluation. Our staff will coordinate the referral services with the member's
CMH center.
Q. When should I coordinate care with the PCP via written notification?
A.
After the initial assessment.
