Providers rendering services to health plan members must comply with all Medicaid provider requirements outlined in the Medicaid provider manuals however; they do not need to be a Medicaid enrolled provider. Participating providers are required to accept the health plan’s rates for payment for covered services as payment in full. Providers should not bill the member for any amount other than copays and services not covered under the member’s benefit.
Primary Care Physicians
Each Ingham Health Plan (IHP) primary care physician (PCP) is responsible for coordinating the member’s total health care. All covered health services are either delivered by the PCP or are referred/approved by the PCP and/or the IHP. In addition, the PCP is responsible for initiating referrals for specialty care, maintaining continuity of care, maintaining the member’s medical records, and for assuring that the services provided are of appropriate quality and intensity for the member’s condition.
Specialty Care Physicians
Specialty physicians are valuable partners in delivering care to our members. Specialty physicians are responsible for services re- quested by the PCP, communicating with the PCP regarding medical findings, and obtaining prior-authorization before rendering services outside of an office visit.
Participating providers shall continuously meet all of the following standards:
- Possess an unrestricted license to practice in Michigan and experience no revocation, corrective action, suspension or other related disciplinary action or sanction under federal or state law
- Be authorized under federal and Michigan law to prescribe all drugs and biologicals required to be administered in providing covered services
- To the extent the participating provider is practicing in a particular field or specialty other than primary care, the participating provider shall be board certified or board eligible in that field or specialty
- Experience no debarment or suspension by any federal or state agency or experience no suspension, termination or exclusion from participating in Medicare, Medicaid, Blue Cross/Blue Shield or any other federal or state health care program or private third party payer program
- Experience no criminal convictions related to federal health care programs
- Adhere to professional standards of practice and ethics.
The registration processes requires all providers to complete the IHP Provider Registration form on behalf of the office and all the corresponding practitioners rendering services to IHP members. Offices requiring an IRS 1099 should also submit a W-9. The Provider Registration form can be found under the Forms Menu or by clicking here.
Providers should keep the IHP updated with changes in credentials, office information including telephone number, tax ID number, payee address, office physical address, office hours, open/closed status regarding new members, and physicians/practitioners joining or leaving the practice location. In conjunction with this, providers should respond promptly to any IHP requests to update information so that all credentialing files can be maintained appropriately and clean claims can be processed quickly. Failure to provide IHP with updated with your information may result in slower claim payments.