MERIDIAN HEALTH PLAN

MERIDIAN HEALTH PLAN 333 South Wabash Avenue

Suite 2900 Chicago, IL 60604 Phone: 312-705-2900 Fax: 312-980-0404

CONTENTS

Contact Us HEDIS Bonus Program Member Engagement Claims

Payments, Status & Billing Claims Appeal Process EDI Submission Claim Billing Requirements Meridian Members No Co-Pays Pharmacy Benefits Meridian Service Area Product Descriptions Referral Guide Fraud, Waste & Abuse To Report Potential Fraud, Waste & Abuse Annual Training Program Quick Reference/Contact Information

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CONTACT US

PHONE Call 866-606-3700 or contact your Provider Network Development Representative directly.

You are assigned a local Provider Representative to handle any questions or concerns

WEBSITES

Use Meridian Health Plan's website to access these features:

? Provider Manual & Orientation

? Provider Directory

? Formulary ? Bulletins/Updates

? Important Forms

? Live Chat Services

PROVIDER PORTAL il/mcs

The Provider Portal gives contracted providers exclusive access to these features:

? Member Eligibility Verification

? Authorizations

? Claims Status and Submission/Correction

? Meridian Member Information & Reports

? Enrollment Lists

? HEDIS Bonus Information

? HEDIS Self-Reporting

? Member Utilization/Health History

? Contact Meridian departments directly

A Meridian-supplied user name is required for access to the Provider Portal. To sign up, please visit il/mcs.

Questions? Please contact your Provider Network Development Representative.

MISSION To continuously improve the quality of care in a low resource environment.

VISION To be the premier service organization in healthcare.

To be the #1 health organization based on quality, innovative technology and service to our members.

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HEDIS BONUS PROGRAM

Committed to ensuring quality care for our members, Meridian offers a HEDIS Bonus Program for all contracted providers. The program includes generous incentives ranging between $20 and $200 per service.

PROGRAM HIGHLIGHTS ? Paid over $18 million to participating providers (2012)

Bonus structure varies by line of business. For more details, please reference the Meridian Provider Incentive Program Overview online at il/providers. If you have any questions about the HEDIS bonus program, or what bonuses you may qualify for, visit our website at or call your Provider Network Development Representative.

MEMBER ENGAGEMENT

As part of the enrollment process, Meridian utilizes claims data and various risk assessments to automatically enroll members in outreach programs that meet their level of need. Providers can refer members to the Disease Management, Care Coordination or Complex Case Management programs as needed through the by:

? Clicking the "Notify Health Plan" button on our Provider Portal

? Calling Meridian at 866-606-3700 ? Faxing in the "Care Coordination/Complex Case Management Referral Form" to Meridian. This form can be found online at il/providers, in the "Documents and Forms" section

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Claims Data

Member Welcome Call Risk Assessments

Strati cation

Low

Medium

High

Health Outreach Program

Preventive Care Reminders (phone and mail based)

Care Coordination Program

Preventive Care Reminders (phone, community and mail based) Condition-Speci c Education Personal Care Coordinator Transition Management Person-Centered Plan of Care Interdisciplinary Care Team

Complex Case Management Program

Preventive Care Reminders (phone and mail based) Condition-Speci c Education Complex Case Manager Intensive Case Management Transition Management Person-Centered Plan of Care Interdisciplinary Care Team

Disease Management Program (included at all strati cations) Preventive Care Reminders (phone and mail based) and Condition-Speci c Education

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PROGRAM DESCRIPTIONS

Health Outreach Program

Low InteDrviseeansetiMoannaLgeevmeelnt

Care Coordination

Complex Case

Periodic outreParcohgr,aams applicable, to remind mPeromgrbamers of important preMveannatgivemeent Program

services such as well visits and important screenings.

Disease Management Program

Low IntervCaernetCiooorndiLneatvioenl + Self- ManagemCeonmtplNexeCeadses Available to alPl reolgigraimble members. IncludMeasnaegdeumceantiPornogfroamr the following conditions:

? Asthma ? Cardiovascular Disease ? Diabetes ? Emphysema/COPD

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