We are excited to share that MeridianCare, a WellCare company, is changing its name to WellCare, effective January 1, 2020!
Acknowledgment of Hysterectomy Form
Behavioral Health Discharge Transition of Care Form
Care Coordination/Complex Case Management Referral Form
Electronic Medical Request Form
HealthHelp and eviCore Provider Notification
MeridianHealth - Illinois Prior Authorization Requirements
Mobile Crisis Response Provider Reference Guide
Medication Prior Authorization Request Form
Member Request for Reimbursement Form
Online Pharmacy Prior Authorization (PA)
For additional pharmacy information, click here.
FORM144 IL Crossover Claim Resolution
Billing Guidelines for EAPG Pricing
C32 Provider Billing Education Guidance
D01 Duplicate Claim Submissions Guidance
Electronic Funds Transfer Form
Guidelines for Custodial and Supportive Living Authorizations
HFS Managed Care Billing and Encounter Guidelines - DASA
Hospice Routine Home Care and Continuous Home Care
IAMHP Comprehensive Billing Manual
IAMHP Memo to All Health Plans
Illinois Medicaid Fee Schedule
Medical Assistance Program (MAP) Guidelines
MTM Transportation Billing Guidelines Review
Pharmaceutical Labelers with Signed Rebate Agreements
Physician Assistant Billing Guidelines
Renal Dialysis Value Code Requirements
▤ Request for Provider Dispute Form
Timely Submission of Encounter Data by Medicare-Medicaid Plans (MMPs) to CMS
Adolescent Immunization Exclusion Form
Adolescent Immunization Schedule
Breast Cancer Screening Exclusion Form
Cervical Cancer Screening Exclusion Form
Child Immunization Exclusion Form
Follow-Up After Hospitalization for Mental Illness (FUH)
MeridianHealth offers vision benefits to members enrolled in specific health plans.
Click here to view a chart summarizing the vision benefits available to members in each of our Illinois health plans.
Instructions – Ordering Vision Hardware from Classic Optical Laboratories (for Medicaid and Medicare-Medicaid Alignment Initiative (MMAI) members)
Order Form – Classic Optical Laboratories
Instructions – Ordering Vision Hardware from JAK Optical Laboratories (for Medicaid and Medicare-Medicaid Alignment Initiative (MMAI) members)
Meridian's Advance Directives Information
Directivas Anticipadas información de Meridian
Power of Attorney for Health Care
Resources for Illinois Advance Directives
Testamento Vital
Illinois Client Enrollment Services
Illinois Dept of Healthcare and Family Services
Medicare Provider- Supplier Enrollment
Page Last Modified: 4/5/2022 2:50:09 PM