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Provider Notices

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YouthCare

Looking for information about YouthCare?

YouthCare Website

If your member is having difficulties filling prescriptions or obtaining basic necessities such as diapers, formula or groceries, please contact Provider Services at 866-606-3700

If you are a non-participating provider and do not yet have a contract with Meridian, the Meridian Care Coordination and/or Utilization Management team will work with you and the member to transition care to a Meridian participating provider during the transition of care period. 

As always you can talk directly with your Provider Representative about any concerns regarding the status of your contract or send an inquiry to Providerhelp.IL@mhplan.com

 

Contact

Call Provider Services at 866-606-3700 (TTY 711) with any questions.

Email support is available at providerhelp.il@mhplan.com

 

Health Library

The Health Library is a free resource exclusively for Meridian members and providers where you can get tips to help your patients manage their health.

You’ve got questions, we’ve got answers. If there’s a question you can’t find the answer to on our website, call Provider Services at 866-606-3700 (TTY 711)

Visit our Billing & Payments page for more information.

You can find the Provider Manual along with the Claims Provider Manual on our Provider Manual Page. You can find our Prior Authorization and Referral Guide on our Documents and Forms page under Medical Referrals and Authorizations. 

MeridianHealth is happy to assist providers with claim status!

Providers are able to check claims status using our self-service tool by calling Member Services at 866-606-3700. Please have the NPI, claim number, and member information available when using this tool.

Learn more about what Meridian can do for you on our Why Meridian? page.

To become a contracted Meridian provider, call Provider Services at 866-606-3700.

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. 

Primary Care Providers

MeridianHealth 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

MeridianHealth 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.

No. Providers can choose whether or not they will accept new patients.

Yes, contracted PCPs with MeridianHealth are given complete control over their panels. They can determine the number of patients they will accept, as well as any gender or age restrictions.

Please call Meridian Provider Services at 866-606-3700.

Members will continue to receive their HFS MEDI card once enrolled with MeridianHealth. They will also receive a MeridianHealth 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 MeridianHealth at 866-606-3700 to confirm benefits.

No. In-Network PCPs do not need a referral to see a MeridianHealth member, even if the member is not assigned to them.

No. In-network specialists do not need a referral to provide services in their offices.

PAs, NPs, and APNs are able to contract directly with Meridian Health Plan.

Yes. MeridianHealth pays all of the provider add-ons that the state pays.

Yes. MeridianHealth follows the State of Illinois billing guidelines unless otherwise noted.

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.

Unlimited outpatient visits are available.

No.

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 (PDF) to 313-202-1268.

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.

No. Meridian reimburses for one "Psychiatric diagnostic interview examination" (CPT Code 90801) per year per provider group.

Call the Meridian Behavioral Health Department at 888-222-8041 to notify us of your evaluation. Our staff will coordinate the referral services with the member's CMH center.

After the initial assessment and for ongoing coordination after the 3rd visit by sharing the COTNF.


NCQA Accredited - Commendable

 

Meridian Health Plan of Illinois, Inc. is rated 3.5 out of 5 in NCQA's Medicaid Health Insurance Plan Ratings 2016-2017 and NCQA's Medicaid Health Insurance Plan Ratings 2017-2018.