Provider Relations

Meridian has the most extensive statewide health plans in Illinois, and our providers exemplify our mission to deliver the highest quality of care to transform the health of communities, one person at a time. The Meridian Provider Relations Department welcomes and assists new and established providers as they fulfill that mission. Providers can also use our Meridian Quick Reference Guide (QRG) (PDF) as a tool to assist with common administrative questions.  

Claims

  1. Please file a reconsideration before submitting a claim for review and possible reprocessing
  2. Please follow the reconsideration process noted in the provider portal before contacting Provider Relations
  3. If a payment reconsideration is upheld, or you disagree with the determination, please submit a completed universal claims template, and identify the reason for the dispute. When submitting the spreadsheet, include the reconsideration number provided to you
  4. Please provide a separate spreadsheet for each line of business:
    • Meridian Medicaid Plan (Meridian), Ambetter of Illinois (Ambetter), Meridian Medicare-Medicaid Plan (MMP), Wellcare of Illinois (Wellcare), YouthCare HealthChoice Illinois (YouthCare), and Behavioral Health
  5. Include the contact person’s name, number, and email address for follow-up and next steps
  6. If the claims issues are related to new HFS rates, please attach a copy of the expected reimbursement per state guidance
  7. If the claims issues are related to underpaid claims, please provide the anticipated rate

The Roster

Please include a completed universal roster when contacting us about issues. Then attach and submit the completed universal roster form in your Provider Relations Intake Form submission.

We can assist with concerns such as,

  1. Providers flagged as non-Par
  2. Termination of providers from a practice
  3. Adding providers to a practice
  4. Address and contact information updates
  5. Providers listed on Find a Provider (FaP) but coming up as non-Par
  6. Providers recorded inaccurately on FaP

Contracting

To sign up or check the status of a new contract, an amended contract, or a rate negotiation, please email us at IL Join Our Network, ILJoinOurNetwork@CENTENE.COM.

Authorization

  1. For peer-to-peer requests, please call 866-322-8844 0065, ext. 26155
  2. If you have concerns with prior authorizations, peer-to-peer engagements, or an urgent authorization requestion, please log in to the plan’s website:

Portal Access

Please complete an intake form if you have issues with portal access or would like portal advice, such as submitting claims or checking claims status.