Frequently Asked Questions for Members & Providers
WHAT IS THE INGHAM HEALTH PLAN?
The Ingham Health Plan is a community sponsored program that helps uninsured people get health care services. It is not insurance.
WHO QUALIFIES FOR THE INGHAM HEALTH PLAN?
Ingham County residents who make less than $36,450 for 1 person (250% of the federal poverty limit) per year who do not have any other comprehensive medical or dental coverage.
HOW DOES THE PROGRAM WORK?
Members are assigned to a primary care provider at enrollment. The member must receive all his/her primary care at this office. This provider also coordinates all specialty care the member needs.
WHAT IS COVERED UNDER IHP ?
The Ingham Health plan covers most outpatient services including office visits, x-rays, labs, diagnostic tests, surgery, physical therapy, urgent care, limited behavioral health, CPAP machine and supplies and medications. IHP also covers dental services such as cleanings, x-rays, and simple restorations at no charge. More extensive dental services are covered with a copay. Members should refer to their guidebook for a complete listing of covered services.
WHAT IS NOT COVERED UNDER IHP?
The Ingham Health Plan does not cover emergency room services, ambulance services, inpatient hospital services, durable medical equipment, chemotherapy, dialysis, and routine vision services. Members should refer to their guidebook for a complete listing of non-covered services.
WHAT IF A MEMBER NEEDS A NEW IHP CARD?
Call the Ingham Health Plan at 866-291-8691, Monday—Friday 8am-5pm or email firstname.lastname@example.org
You can also get a temporary card by visiting the portal.
WHAT IS THE MEMBER'S IHP IDENTIFICATION NUMBER?
The member's Ingham Health Plan identification number for the medical program starts with the letters HPMS followed by six or seven digits. It is not the patient's social security number or recipient identification number. The IHP ID may be obtained by looking at the member's IHP card, accessing the IHP eligibility system, or calling member services at 866-291-8691. Members will receive a Dental Delta card for dental services. Members will be assigned a different identification number by Delta Dental. This will not be the patient’s social security number, recipient identification number, or HPMS number.
HOW DO I STATUS A CLAIM?
Claims can be statused 1) online by visiting the portal,2) by phone at 1-866-291-8691, 3) by fax at 517-394-4590, or 4) by email email@example.com within 45 days after submission
HOW DO I SUBMIT A CLAIM CORRECTION OR APPEAL?
If you need to file an adjusted claim, providers should complete and attach the Claims Appeals-Adjustments Form to a corrected claim and fax the documents to 517-394-4590. Providers needing to appeal a claim rejection, should complete the Claims Appeals-Adjustments Form and attach supportive documentation such as clinical notes or screen prints. These should be faxed to 517-394-4590. Claim adjustment or appeal requests will be reviewed by the health plan within 30 calendar days. The provider will receive a written response on any denied requests.
WHAT RATE WILL I BE PAID?
The IHP will reimburse office visits as rates to similar to Medicare rates. Other covered services are reimbursed at a rate that is greater than or equal to the Medicaid fee-for-service rate or the provider's usual and customary charge, (whichever is less), minus any required copay amount.
HOW LONG DO I HAVE TO SUBMIT A CLAIM?
Providers may submit claims up to one year from the date of service for payment. Providers who did not receive a response, may request a filing extension of up to 120 additional days if there is documentation showing a initial claim was sent to the IHP within the one year filing limit. Providers should complete the Claims Appeals-Adjustments Form and attach the supportive documentation to the claim. These must be faxed to 517-394-4590. Providers must submit adjusted and ap- pealed claims within 12 months from the date the claim was originally denied.
I AM A NEW PROVIDER, HOW DO I PARTICIPATE?
The IHP does not contract with any providers other than primary care physicians (PCP). All other practitioner types may become participating providers simply by attaching a completed W-9 and a Health Plan Provider Registration Form to their first claim submission. These forms can be accessed by clicking on Forms under the Quick Links menu. A PCP wishing to participate must contact our Provider Relations department at 866-291-8691 for more information.
HOW DO I CHANGE MY OFFICE'S PAYMENT INFORMATION?
Providers must submit changes using the Health Plan Provider Registration Form. An updated W-9 should accompany the form. These can be mailed to PO Box 30125, Lansing, MI 48909 or faxed to 517-394-4590.
DOES THE IHP ACCEPT ELECTRONIC CLAIMS?
Yes. The IHP accepts both professional and institutional electronic claims through its clearinghouse Emdeon. Claims must be in 837 file format for electronic submission. The CHP electronic payer ID is 38343 . Providers should refer to the IHP Claims Submission Guidelines.
DOES IHP REQUIRE PRIOR AUTHORIZATION FOR CLAIMS TO BE PAID?
We encourage providers to authorize all diagnostic tests and procedures performed in the office or hospital, with the exception of office visits. Some services do require medical review. Refer to the authorization page for a complete listing.
DOES THE IHP COORDINATE BENEFITS (COB) WITH OTHER PAYERS?
The IHP is the payer of last resort. Members should not have any other coverage with the exception of Medicaid ESO or Medicaid with a Spend-down. The IHP will not coordinate benefits with other policies, including Auto Insurance.
HOW DO I REFUND THE IHP?
Providers may send refund or voided checks to the IHP when an overpayment occurs. Necessary supportive documentation is required and needs to be attached to the refund such as a refund request letter, the IHP's EOB, and/or the primary insurance's EOB. Providers should also include an explanation as to why the service is being refunded. Checks must be made payable to the health plan listed on the EOB.
Refund checks should be sent to the following address: P.O. Box 30125, Lansing, Michigan 48909