Q: What are the advantages of Meridian Health Plan?
A: MHP maintains an administrative and organizational structure that supports a high quality, comprehensive care management program. MHP's approach and organizational structure ensures effective linkages between 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 it to have substantial flexibility in its relationships with its providers and hospitals. MHP's management believes that practitioners should have as much freedom as possible to practice medicine. It is with this goal in mind that MHP has developed a nearly paperless authorization system including an online Managed Care System (MCS) for use by all contracted providers.

Meridian Health Plan provides a wide range of both preventive and therapeutic health care services to its Medicaid population. MHP takes great pride achieving high standards regarding HEDIS measures and implements technically advanced actions to ensure its success.

Q: How can I apply to MHP?
A: In order to assure 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 Illinois 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 at (866) 606-3700 or email bschoen@mhplan.com

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 arrangements 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 guarantee claim payments to Specialist Providers within 10 days of receiving a clean claim for all authorized services provided to a member.

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 the members of their community with as little interference as possible

Q: As a participating Meridian Health Plan provider, do I have to accept new patients?
A: No. Providers can choose whether or not they will accept new patients.

Q: If I become a contracted PCP, can I limit the amount of patients I accept?
A: Yes, Contracted PCPs with Meridian Health Plan 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.

Q: Do all public aid recipients qualify for Meridian Health Plan?
A: Only public aid recipients that reside within our service area are able to select Meridian Health Plan for medical coverage. These individuals will have to qualify for the AllKids, FamilyCare, or Moms and Babies programs to select MHP. They also cannot have third party liability or be part of the spend-down program. Meridian Health Plan is the primary payor of Medicaid covered benefits for its enrolled members.

Q: How does a member enroll with Meridian Health Plan?
A: Public aid recipients may enroll with Meridian Health Plan as they currently do with the state. Potential members will access the local DHS office and submit paperwork to qualify for coverage. If the state grants them public aid, they will have the option of selecting Meridian Health Plan with the Illinois Client Enrollment Broker by completing an enrollment packet.

If a member is already receiving public aid, they will simply need to call the Illinois Client Enrollment Broker at 1-877-912-8880 to select Meridian Health Plan.

Q: Why would a member want to join Meridian Health Plan?
A: Meridian Health Plan offers many benefits for our members, such as:

  • No Co-Payments for any covered benefit, including pharmacy
  • Transportation to and from the provider’s office, health departments, WIC appointments, FQHCs, DME offices and pharmacy
  • Healthy Incentives Program that will allow qualifying members to earn $10 or $50 gift cards for completing designated preventive services
  • Weight Management Programs

Q: Do PCPs need a referral to see a Meridian Health Plan member not assigned to their panel?
A: No. In-Network PCPs do not need a referral to see a Meridian Health Plan member even if they are not assigned to them

Q: Do Specialists need a referral to provide services to a Meridian Health Plan member in their office?
A: No. A referral is not needed for Specialists to provide services in their office.

Q: Can PAs, NPs, and APNs contract w MHP?
A: NPs and APNs are able to contract directly with Meridian Health Plan. At this time PAs are unable to contract with MHP, but are able to provide services to our members and submit claims under their supervising physician for reimbursement.

Q: Does Meridian Health Plan pay the provider add-ons that the State of Illinois pays?
A: Yes. Meridian Health Plan pays all of the provider add-ons that the state pays.

Q: How do I verify a Meridian Health Plan member’s eligibility?
A: Members will continue to receive their HFS MEDI card once enrolled with Meridian Health Plan. They will also receive a Meridian Health Plan 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 the can call Meridian Health Plan directly and speak with a live person to confirm benefits.

Q: What is the time frame for reimbursement to providers?
A: Meridian Health Plan reimburses its claims within 10 business days and has done so in all lines of business for the past 9 years.

Q: Do you follow the State of Illinois billing guidelines?
A: Yes. Meridian Health Plan follows the State of Illinois billing guidelines unless otherwise noted.