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 Washtenaw Health Plan (WHP) 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 WHP. 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 also valuable members in delivering care to our members. Specialty physicians are responsible for services requested by the PCP, communicating with the PCP regarding medical findings, and obtaining prior-authorization when necessary.

Provider Registration

The registration processes requires all providers to complete the WHP Provider Registration form on behalf of the office and all the corresponding practitioners rendering services to WHP 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 plan updated with changes in credentials and 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 WHP requests to update information so that all credentialing files can be maintained appropriately and clean claims can be processed quickly. Failure to provide the plan with updated information may result in slower claim payments.