Transcript MERIDIAN 2016 PAYOR CONFERENCE

About Meridian Health Plan
Our Mission:
To continuously improve the quality of care in a low resource environment
We are:
• Family-owned and operated treating our employees, members and
providers like our own
• Dedicated to making a difference through quality, innovative
technology, member and provider satisfaction
Vision:
• To be the premier service organization in government healthcare
• To be the #1 health organization based on quality, innovative technology
and service to our Meridian Family
Meridian is the only multi-state plan in the nation to receive an overall rating of 4
out of 5 for all three Medicaid HMO products – Meridian Health Plan of Michigan,
Meridian Health Plan of Illinois and Meridian Health Plan of Iowa*
*According to NCQA’s Medicaid Health Insurance Plan Ratings 2015–2016
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Meridian Programs
Prior Authorization Updates
• Provider Portal SubmissionPreferred Method
• Universal Online Form
– Authorization form can be
found on our website at
https://mhplan.com
• Provider Tools
Prior Authorization Updates
• Universal Online Form
– Complete all required
sections
– Include clinical
documentation
– Print form and fax to
313-309-8580
Change of Address – Meridian Appeals
• Meridian Care and Meridian Complete:
Meridian Health Plan
ATTN: Appeals Department
P.O. Box 44260
Detroit, MI 48226
• Meridian Health and Meridian Choice
Meridian Health Plan
ATTN: Appeals Department
P.O. Box 44287
Detroit, MI 48244
HEDIS Bonus Program
• Updates effective 10/1/2016
– Comprehensive Diabetes
• HbA1c Control updated from <7% to <8%
– Chlamydia Screening
• $35 if service is billed by assigned PCP
• $25 if service is found through medical record review or
billed by provider other than assigned PCP
– Prenatal and Postpartum Care
• Updated to a quarterly bonus
• Split between PCP and Servicing Provider
HEDIS Bonus Program
• Updates effective 10/1/2016
– Added
• Colorectal Cancer Screening - $20
– Removed
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Follow-Up After Hospitalization
Smoking Cessation
Cervical Cancer Screening
Prenatal and Postpartum Care
HEDIS Bonus Program
• Updates effective 10/1/2016
– Added
• Colorectal Cancer Screening - $20
– Removed
• Follow-Up After Hospitalization
• Smoking Cessation
HEDIS Bonus Program
• New Program Effective 1/1/2017
– Cervical Cancer Screening $25
– Prenatal and Postpartum Care $100-$200
• payment to be split between PCP and in-network servicing provider
– Chlamydia Screening $25
– Weight Assessment and Counseling for Nutrition and Physical Activity
for Children/Adolescents
• $15 for completion of Child BMI Percentile (ages 3-17), Counseling for
Nutrition, and Counseling for Physical Activity (must complete all)
– Well Child Visits 3-6 $25
– Initiation and Engagement of Alcohol and Other Drug Dependence
Treatment
• will be paid to servicing provider $25 for each component
– Comprehensive Diabetes Care $25-$100
QUESTIONS?