Visit Us Online at MclarenHealthPlan.org MHP

McLaren Health Plan is pleased to announce that we were awarded a contract with MDHHS to provide health care services to Medicaid Recipients in all 68 counties in Lower Michigan. This is a significant accomplishment, resulting in McLaren Health Plan being one of only three health plans who can serve the entire lower peninsula. We are excited to expand our service area and look forward to continued collaboration with our Provider Network. 2 Medicaid Bid Results

McLaren Medicaid ID Cards 3

McLaren Health Plan is committed to assisting Provider Offices achieve: Higher Pay for Performance Payment Increased incentive payments to both you and your patients Better patient outcomes when preventive services are provided Increased positive relationships between the plan, your office and your patients The MHP Outreach Team of Professionals can assist your office with in-office or off-site scheduling. During these patient contacts, MHP can assist your patients by: Discussing the importance of preventive care services Determining barriers to care and assisting with such barriers (ie. transportation) Offering Member Incentives If you are interested in working with the Outreach Team, please contact MHP at (888) and ask to speak to an Outreach Representative 4 McLaren Outreach Team

Complete the following to avoid delays in the credentialing process : Update and/or re-attest your CAQH application quarterly Leave no gaps in the most recent five years of work history. Please be sure to include leaves of absences, maternity leaves, moves, etc. Ensure there is a copy of your liability insurance attached to your application and that it is current Provide an accurate credentialing contact Completing these steps will provide you with a smooth credentialing process and reduce interruptions to you and/or your staff. 5 Credentialing

MHP has a Referral to Case Management form for you to use when you need help with your high-risk members.  This form can be found on our website MclarenHealthPlan.org by clicking the Provider tab, selecting Health Management Tools, selecting Health Management and then selecting Case Management. MHP Preventive Health Management helps by:  Informing members of preventive testing and good health practices  Mailing reminders about immunizations, well child visits, and lead screenings  Targeting preventive care measures just for females in our Member Newsletters  Initiating call programs to assist members with scheduling annual checkups and screenings  Keeping track of members who are due for annual checkups and screenings and sending that list to the PCP’s office If you do not know who your nurse is, call Customer Service at (888) Medical Management

Claims Inquires and Payment McLaren Health Plan receives EDI claims from our clearinghouse, ENS Optum Insight. Our Payer IDs for electronic claims are: McLaren Medicaid/MiChild – 3833C McLaren Commercial – McLaren Health Advantage – 3833A McLaren Advantage – 3833R For any claims questions/concerns please contact Customer Service at

Contact Information 8 DEPARTMENTADDRESS AdministrativeMcLaren Health Plan G-3245 Beecher Rd Flint, MI ClaimsMcLaren Health Plan P.O. Box 1511 Flint, MI Provider Referral Form for Pre- Authorization McLaren Health Plan Medical Management G-3245 Beecher Rd Flint, MI or FAX to: or Submit Electronically at MclarenHealthPlan.org

Referral Requirement Updates Effective February 1, 2016, McLaren Health Plan implemented referral requirement changes/updates. Some highlights are: Chemotherapy: No preauthorization required Dialysis: No preauthorization required Spinal Cord Stimulators: Preauthorization required Specialty Medications/Injections: Codes updated Rhinoplasty/Septoplasty: Codes added A full list of CPT/HCPCS codes requiring preauthorization is available on our website: 9

McLaren Health Plan (MHP) is implementing a Pilot Program removing the preauthorization requirement for in-network Physical Therapy (PT), Occupational Therapy (OT), and Speech Therapy (ST) Reminder: It is always necessary for members to coordinate care with their Primary Care Physician to ensure that all care is medically necessary MHP will perform post-payment audits reviewing claims by diagnosis, number of visits, location and member.  These audits will be performed to ensure medical necessity of services being performed. 10 Medicaid/Healthy MI PT, OT, ST Authorization Update

Does your office have access to McLaren Health Plan’s (MHP) Provider Portal? MHP’s Provider Portal will enable Provider offices to: Access Provider Panel Roster View Claims status View Authorizations To request access to MHP’s Provider Portal contact Customer Service at (888) Provider Portal

Key Contacts Customer Service:(888)  Member Eligibility  Member Benefits  Claims Questions Network Development:(888)  Adding New Provider  Contract Questions  Process Questions  Education Requests Outreach Team(888)  Outreach Services Medical Management: (888)  Authorizations  Case Management  Disease Management Hours of Operation: Monday – Friday 8:30 AM – 5:00 PM Customer Service Provider Line: Monday – Friday 7:30 AM – 5:30 PM 12

Visit Us Online at MclarenHealthPlan.org