We are excited to share that MeridianCare, a WellCare company, is changing its name to WellCare, effective January 1, 2020!
Services at888-773-2647 (TTY 711)
with any questions.
Or, you can always contact your Provider Network Development Representative.
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 at888-773-2647 (TTY 711)
How do I submit a claim?
Visit our Billing & Payments page for more information.
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 888-437-0606. 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 at888-773-2647
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 ProvidersHealthy Michigan Plan
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.
Specialist ProvidersHealthy Michigan Plan
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.
How can I check a member's eligibility?
How can I request supplies for our diabetic members?
MeridianHealth members with diabetes are eligible for the Advocate™ Redi-Code (requires no coding) glucometer from Healthy Living Diabetic. For a member to receive a glucometer, the PCP must complete a Healthy Living Medical Supply Form and fax it to Healthy Living Diabetic at 866-779-8511. PCPs may also call 866-779-8512.
The initial glucometer is shipped to the member within 24 hours of receipt of a completed request. The glucometer package includes:
For more information on the Advocate™ Redi-Code Glucometer, please click here.
Do PCPs need a referral to see aHealthy Michigan Plan
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.
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.
Who should I contact if I have general questions related to Meridian?
Please call Meridian Provider Services at 888-773-2647.
What is the behavioral health outpatient benefit for MeridianHealth members?
MeridianHealth (Meridian) provides outpatient mental health services. There is no visit limit and prior authorization is not required.
Do I need to obtain an initial authorization?
No. Meridian provides up to ten (10) outpatient visits without prior notification.
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?
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.
How can I request a Community Health Worker (CHW) referral?
Referrals can be generated by accessing the provider portal or contacting Provider Services at 888-773-2647.
What are work requirements?
The requirements for persons receiving services through Medicaid Expansion or "Healthy Michigan Plan" (HMP) are to participate in at least 80 hours per month of community engagement (work, job training, school, volunteering). Starting January 1, 2020, members must attest to meeting this requirement monthly. The specifics for reporting have not yet been determined. This page will be updated as more information is available.
Why do I have to participate in work requirements?
Public Act 208 of 2018 requires people receiving benefits through HMP to engage in work activities in order to continue getting benefits. Exceptions for this requirement include, but are not limited to, people who are pregnant, medically frail, enrolled in the Flint water waiver, American Indian/Alaska Native, under 21 or are able to demonstrate "good cause" circumstance.
What counts as a work requirement?
Work requirements can include working at a job or internship, attending school, or receiving job or vocational training. For a full list of qualifying activities, visit the Healthy Michigan Plan Work Requirements page.
What requirements do I have to complete to maintain eligibility?
Members will have different requirements based on their annual income and how long they have been enrolled in HMP. Requirements are still being finalized. This page will be updated as more information is available.
Page Last Modified: 4/5/2022 2:50:09 PM