How Can I Check A Member’s Eligibility
Members will continue to receive their HFS MEDI card once enrolled with Meridian. They will also receive a Meridian ID card for each member of their family that is enrolled. This card will have our logo, phone number, PCP name and recipient ID number. Providers can continue to use the on-line MEDI system to check eligibility, or they can call Meridian at to confirm benefits.
What Are My Contract Options As A Health Care Provider In The Meridian Network
Primary Care Providers
Meridian contracts with Primary Care Providers on a fee-for-service basis, with quality bonus incentives in lieu of traditional full risk arrangements. Our focus on quality, instead of risk, allows physicians to do what they do best: treat patients.
Specialist Providers
Meridian values the relationship with our specialist providers and seeks to limit the amount of “red tape” whenever possible, especially with referrals and authorizations. Meridian continues to provide prompt claims payment to specialist providers.
Hospital Providers
Communication is the key to all mutually beneficial relationships. In this regard, Meridian makes every effort to partner with each contracted Hospital in coordinating the care of its beneficiaries. Hospital providers can count on Meridian to help serve their communities with as little interference as possible.
Are Video Visits With A Primary Care Doctor Online Covered By Meridian Health Plan
Most insurers provide coverage for video visits at the same cost as in-person visits. You can search on Zocdoc specifically for Doctors in Naperville who accept Meridian Health Plan for video visits by selecting your carrier and plan from the drop-down menu at the top of the page. We recommend you check with your insurance carrier directly to confirm your coverage and out of pocket costs for video visits.
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How Can I Book An Appointment Online With A Meridian Health Plan Primary Care Doctor In Naperville
Zocdoc is a free online service that helps patients find Meridian Health Plan Doctors in Naperville and book appointments instantly. You can search for Meridian Health Plan Doctors in Naperville by symptom or visit reason. Based on that information, youll see a list of providers who meet your search criteria, along with their available appointment slots.
Now More Than Ever Its Time For You To Get Involved In Your Healthcare
At Ambetter, we care about the health of our members, and we appreciate your membership with us. We are dedicated to providing you and your family with reliable health plans you can count on.
If youre an Ambetter member, your plan renewal information is available in your Online Member Account. Just simply login and well guide you through the renewal process!
Check out our Frequently Asked Questions for important dates and enrollment information.
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Meridianhealth Frequently Asked Questions
GENERAL QUESTIONS
Who is WellCare?
- Founded in 1985 by a group of physicians in Tampa, Fla., WellCare is a successful and fast-growing managed care company focusing on families and children, seniors and those with disabilities and other complex medical needs.
- WellCare shares Meridians commitment to providing high-quality care and customer service. They serve approximately 4.4 million members who receive their health insurance coverage through Medicaid, Medicare Advantage and Medicare Part D as of June 30, 2018.
- As of June 30, 2018, WellCare operates Medicaid plans in 12 states, Medicare Advantage plans in 18 states and Prescription Drug Plans in all 50 states and the District of Columbia.
Who is Meridian?
- Meridian serves more than one million Medicaid, Medicare Advantage, integrated dual-eligible and Health Insurance Marketplace members in Illinois, Michigan, Indiana and Ohio.
- Meridian Health Plan of Illinois, Inc. is the highest rated Medicaid plan in Illinois with an overall rating of 4.0 out of 5.0 according to NCQAs Medicaid Health Insurance Plan Ratings for 2017-2018.
How does this benefit me?
- Our focus remains on serving our members needs and an important part of that is expanding their access to quality providers like you.
- We recognize our providers as partners in that mission. We will be looking for all opportunities to make your experience with us even better and to leverage the benefits this acquisition will bring to the table in provider engagement.
Meridian Health Plan Signs Transportation Contract With Mtm
LAKE SAINT LOUIS, MO Medical Transportation Management, Inc. announced today that it has signed a contract with Meridian Health Plan to provide transportation to Illinois beneficiaries. On November 1, 2010, MTM will begin coordinating non-emergency medical transportation for those beneficiaries who are otherwise unable to get to and from medical appointments and services.
Meridian Health Plan is a Medicaid HMO in the State of Illinois, headquartered in Chicago. MHP currently serves eight counties, providing health care to beneficiaries enrolled in the AllKids, Family Care, and Moms and Babies programs through a contract with the Illinois Department of HealthCare and Family Services.
We believe that transportation services are an important and valuable benefit. By offering our beneficiaries safe, reliable transportation to medical appointments, DME providers, and WIC offices, we work to remove barriers that might otherwise prevent our population from receiving the care they require, said Benjamin Schoen, Director of Provider Services for Meridian Health Plan.
Kim Matreci, Vice President of Client Services at MTM said, MTM and MHP are looking forward to working together to ensure a smooth transition and successful implementation of service for beneficiaries. With a shared vision and commitment to safe, quality transportation services, our companies are united in an effort to providing excellent service and beneficiary satisfaction.
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Submit Claims By Mail
Submit all initial claims for adjucation through electronic claims submission or by mail to:
For DOS prior to July 1, 2021Meridian1 Campus Martius, Suite 720Detroit, MI 48226
For DOS on or after July 1, 2021MeridianPO Box 4020Farmington, MO 63640-4402
If you are re-submitting a claim for a status or a correction, please indicate Status or Claims Correction on the claim.
Claims Billing Requirements:
- Providers must use a standard CMS 1500 Claim Form or UB-04 Claim Form for submission of claims to Meridian
- Providers must use industry standard procedure and diagnosis codes such as CPT, Revenue, HCPCS and ICD-10 when billing Meridian
- Specialty physician claims should include a PCP referral form and/or a corporate prior authorization number for payment
- Providers may also submit and check the status of claims electronically via the secure Meridian Provider Portal
- Claim must be original, using national or state form types as applicable. Photo or scanned copies are not accepted. The claim information must be typed, with no hand-written information other than applicable signatures
What Is The Provider Portal
The Provider Portal is a secure, online tool that allows PCPs, specialists and hospitals to view and create online authorizations and referrals, view specific preventive health care services needed for patients, and verify eligibility and status claims online. The Provider Portal is a real-time information system available to all contracted providers free of charge.
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How Do I Notify The Health Plan Of Additional Visits After The 3rd Visit
Meridian requires notification if you anticipate the member will require more than 3 visits for treatment. The notification must include the DSM-IV diagnosis, reason for continued treatment and status of PCP notification. Please fax the completed Continued Outpatient Treatment Notification Form to 313-202-1268.
Nextlevel Health Claims Operations Now Closed
As previously communicated, NextLevel Health ceased operations on June 30, 2020, and its Medicaid membership transitioned to Meridian Health effective July 1, 2020. NextLevel Health is now in the final stages of closeout of its operations.
The NLH Provider Memo posted August 24, 2020 described NextLevel Health requirements for all providers to meet specific claim submission and reconsideration standards to facilitate payment. Timely filing guidelines allowed up to 180 days from the date of service to submit claims. Therefore, providers who provided services for former NLH members for dates of service through June 30, 2020 had until December 31, 2020 to submit claims with date of service June 30, 2020. In addition, all claims disputes must have evidence of timely dispute being filed, and disputes must have been filed within 90 calendar days from the date of notification or denial being issued.
Now that timely filing deadlines for new claims and claim disputes to be submitted has passed, NextLevel Health is no longer accepting any new claim submissions or claim dispute submissions.
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How Can I Find A Top
You can use Zocdoc to find Meridian Health Plan Doctors in Naperville who are highly rated by other patients. These ratings are based on verified reviews submitted by real patients. Every time a patient completes an appointment booked on Zocdoc, theyre invited to review their experience. Each review must comply with Zocdocs guidelines.
Il Youthcare Claims From Meridian
Date:07/16/20
Dear Providers,
YouthCare HealthChoice Illinois, administered by MeridianHealth , is a specialty health plan designed by the Illinois Department of Healthcare and Family Services and the Department of Children and Family Services to serve former youth in care. YouthCare members will reflect Meridian membership in HFS’ MEDI system. You will know they are YouthCare members by their member identification card .
Medical and pharmacy claims must be submitted to YouthCare to ensure appropriate processing and payment. Providers can contact YouthCare at:
- Phone: 844-289-2264
- Pharmacy Help Desk: 800-971-3191
Meridian has also taken steps to assist providers through this process by doing the following:
Sincerely,
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How Do I Renew My Ambetter Plan
Your Ambetter renewal letter will provide the details for your Ambetter coverage. Youll receive this in the mail and it will also be available in your online member account. Be sure to review your plan details closely. If you dont need to make any changes, we will automatically renew your coverage.
If you want to make changes, including enrolling in a different Ambetter plan, you can call us and well help you explore other options. Open Enrollment this year is November 1 January 15.
How Can I Become A Meridian Provider
To become a contracted Meridian provider, call Provider Services at .
In order to ensure and maintain a high level of medical care, all providers are credentialed by Meridian. Appropriate contracts and applications are provided along with a questionnaire regarding office function, personnel and the potential capacity to service more members.
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How Can I Make A Same
On average, patients who use Zocdoc can search for a Primary Care Doctor in Naperville who takes Meridian Health Plan insurance, book an appointment, and see the Primary Care Doctor within 24 hours. Same-day appointments are often available, you can search for real-time availability of Doctors in Naperville who accept Meridian Health Plan insurance and make an appointment online.
Population Health Management Programs
Our Population Health Management Programs are offered to MeridianHealth members and designed to improve your overall health and quality of care. Please review the various programs below. For more information, or to find out how to get enrolled, please contact MeridianHealth at 866-606-3700.
Affinity Patient Coordination
MeridianHealth partners with Affinity Patient Coordination to provide pharmacist-driven care coordination that assists members in managing their medications. Additionally, members who take six or more medications may be able to participate in a pill pack program to get their medications delivered right to their home.
Complex Case Management
Meridian’s Complex Case Management Program assists members with all their healthcare needs by giving them tools to combat their chronic conditions and navigate their appointments and benefits.
Flu Outreach
The Flu Outreach Program is an educational program used to increase accessibility to the flu vaccination in order to add value towards preventative care and keeping members healthy.
Opioids
The Opioids Program is a set of initiatives intended to combat issues surrounding opioids prescribed through multiple pharmacies, multiple providers and at a high dosage.
Rescue Inhaler Overutilization
Risk for Kidney Failure
The Risk for Kidney Failure Program provides educational outreach intended to help provide resources to those who are at risk for developing end stage renal disease .
Smoking Cessation
Transition of Care
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How To Write
Step 1 Enter the Date of Request.
Step 2 In Patient Information, you will need to provide the patients name, their member ID number, their gender, their date of birth, and their phone number.
Step 3 In Prescriber Information, enter your name and specialty, your NPI number, your office phone number, your office fax number, and list an office contact person.
Step 4 In the Diagnosis and Medical Information, enter the type of medication, the strength and route of administration, the frequency, the patients height and weight, the expected length of therapy, the quantity, the patients BMI and date calculated, the patients blood pressure and the date it was taken, the related diagnosis, and any drug allergies that the patient may have.
Step 5 Beneath Rationale for Prior Authorization, you must write your justification for requesting this medication/prescription. Then, list the name, the reason for failure and the date of failure for any other medication that this patient has taken to treat this diagnosis.
Step 6 Finally, you must include the most recent relative laboratory results to accompany your submission.
