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Q: What
are the advantages of Health Plan of Michigan?
A: HPM
maintains an administrative and organizational structure that supports
a high quality, comprehensive care management program. HPM's approach
and organizational structure ensures effective linkages between administrative
areas including member services, provider support services, network
development, quality improvement, grievance/complaint management, medical
information systems (MIS), utilization and case management.
Health Plan of Michigan's size allows it to have substantial flexibility
in its relationships with its providers and hospitals. HPM's management
believes that practitioners should have as much freedom as possible
to practice medicine. It is with this goal in mind that HPM has developed
a nearly paperless authorization system including an online Managed
Care System (MCS) for use by all contracted providers.
Health Plan
of Michigan provides a wide range of both preventive and therapeutic
health care services to its Medicaid population. HPM takes great pride
achieving high standards regarding HEDIS measures and implements technically
advanced actions to ensure its success.
Q:
What is MCS?
A:
Health Plan of Michigan has implemented an innovative Managed
Care System (MCS), which allows online authorizations to be
viewed, created and authorized by our PCPs, Specialists and Hospitals.
In addition to referrals and authorizations, providers may view specific
preventive health care services needed for their own patients, verify
eligibility and status claims online. The MCS is a real time information
system that all contracted providers have access to free of charge.
Q:
How can I apply to HPM?
A: In
order to assure and maintain a high level of medical care, all providers
are credentialed by HPM. Appropriate contracts and applications are
provided along with a questionnaire regarding office function, personnel
and the potential capacity to service more enrollees. Both HPM and the
State of Michigan require proof of licensure and appropriate malpractice
insurance coverage. In the case of an agreement with a Physician Hospital
Organization (PHO) or a Physician Organization (PO) that has already
credentialed member providers, HPM will consider the option of delegating
that responsibility to the PHO/PO.
To
receive information on becoming a contracted Provider with Health Plan
of Michigan, please contact our Provider Services Department at (888)
773-2647 or email kwalker@hpmich.com.
Q:
What are my contract options as
a health care provider in the HPM network?
A: Primary
Care Providers: HPM contracts with primary care physicians
on a fee for service basis, with quality bonus incentives in lieu of
traditional full risk arrangements. This focus on quality instead of
risk arrangements allows physicians to do what they do best...Treat
Patients.
Specialist Providers: HPM values the relationship with
our Specialist Providers and seeks to limit the amount of "red
tape" whenever possible, especially with referrals and authorizations.
HPM continues to guarantee claim payments to Specialist Providers within
30 days of receiving a clean claim for all authorized services provided
to a member.
Hospital
Providers: Communication is the key to all mutually beneficial
relationships. In this regard, HPM makes every effort to partner with
each contracted Hospital in coordinating the care of its beneficiaries.
Hospital Providers can count on Health Plan of Michigan to help serve
the members of their community with as little interference as possible.
For more information see the links below.
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