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Visit Us Online at MclarenHealthPlan.org
MHP20160807
Medicaid Bid Results
 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.
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McLaren Medicaid ID Cards
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McLaren Outreach Team
McLaren Health Plan is committed to assisting Provider Offices achieve:
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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) 327-0671 and ask to speak to an Outreach Representative
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Credentialing
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.
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Medical Management
 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:
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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) 327-0671.
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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 – 38338
 McLaren Health Advantage – 3833A
 McLaren Advantage – 3833R
For any claims questions/concerns please contact
Customer Service at 888-327-0671
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Contact Information
DEPARTMENT
ADDRESS
Administrative
McLaren Health Plan
G-3245 Beecher Rd
Flint, MI 48532
Claims
McLaren Health Plan
P.O. Box 1511
Flint, MI 48501-1511
Provider Referral Form for PreAuthorization
McLaren Health Plan
Medical Management
G-3245 Beecher Rd
Flint, MI 48532
or
FAX to: 877-502-1567
or
Submit Electronically at
MclarenHealthPlan.org
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Referral Requirement Updates
 Effective February 1, 2016, McLaren Health Plan implemented referral requirement
changes/updates. Some highlights are:
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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: www.MclarenHealthPlan.org
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Medicaid/Healthy MI
PT, OT, ST
Authorization Update
 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.
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Provider Portal
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) 327-0671
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Key Contacts
 Customer Service:
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Member Eligibility
Member Benefits
Claims Questions
 Network Development:
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(888) 327-0671
Outreach Services
 Medical Management:
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(888) 327-0671
Adding New Provider
Contract Questions
Process Questions
Education Requests
 Outreach Team
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(888) 327-0671
(888) 327-0671
Authorizations
Case Management
Disease Management
Hours of Operation:
Customer Service Provider Line:
Monday – Friday 8:30 AM – 5:00 PM
Monday – Friday 7:30 AM – 5:30 PM
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Visit Us Online at MclarenHealthPlan.org