We are excited to share that MeridianCare, a WellCare company, is changing its name to WellCare, effective January 1, 2020!
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
Services at866-606-3700 (TTY 711)
with any questions.
Email support is available at firstname.lastname@example.org
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, callProvider
Services at866-606-3700 (TTY 711)
How do I submit a claim?
Visit our Billing & Payments page for more information.
Where can I find the Provider Manual and information on Prior Authorizations?
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.
How do I request claim status?
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.
What are the advantages of becoming a Meridian Provider?
Learn more about what Meridian can do for you on our Why Meridian? page.
How can I become a Meridian provider?
To become a contracted Meridian provider, call Provider Services at866-606-3700
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.
What are my contract options as a health care provider in the MeridianHealth network?
Primary Care ProvidersMeridianHealth
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.
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.
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.
As a participating MeridianHealth provider, do I have to accept new patients?
No. Providers can choose whether or not they will accept new patients.
If I become a contracted PCP, can I limit the amount of patients I accept?
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.
Who should I contact if I have questions regarding my Provider affiliation status or general questions related to Meridian?
Please call Meridian Provider Services at866-606-3700
How can I check a member's eligibility?
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 at866-606-3700
to confirm benefits.
Do PCPs need a referral to see aMeridianHealth
member not assigned to their panel?
No. In-Network PCPs do not need a referral to see a MeridianHealth member, even if the member is not assigned to them.
Do Specialists need a referral to provide services toMeridianHealth
members in the office?
No. In-network specialists do not need a referral to provide services in their offices.
Can PAs, NPs, and APNs contract with Meridian Health Plan?
PAs, NPs, and APNs are able to contract directly with Meridian Health Plan.
Does MeridianHealth pay the provider add-ons that the State of Illinois pays?
Yes. MeridianHealth pays all of the provider add-ons that the state pays.
Do you follow the State of Illinois billing guidelines?
Yes. MeridianHealth follows the State of Illinois billing guidelines unless otherwise noted.
What is the Provider Portal?
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.
What is the behavioral health outpatient benefit for MeridianHealth members?
Unlimited outpatient visits are available.
Do I need to obtain an initial authorization?
How do I notify the health plan of additional visits after the 3rd visit?
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 to 313-202-1268.
Do I need to obtain authorization for psychological testing?
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.
Can both the psychiatrist and the therapist who are engaged in the same episode of care each bill for a 90801?
No. Meridian reimburses for one "Psychiatric diagnostic interview examination" (CPT Code 90801) per year per provider group.
If a member appears to be suffering from a Severe Mental Illness (SMI) how do I connect the member to Community Mental Health (CMH)?
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.
When should I coordinate care with the PCP via written notification?
After the initial assessment and for ongoing coordination after the 3rd visit by sharing the COTNF.
Page Last Modified: 4/5/2022 2:50:09 PM