Introduction
On this page:
- About MercyOne Health Plan
- Important News and Updates to this Manual
- Provider Communications
- How to Contact the Plan
- Additional Resources
About MercyOne Health Plan
MercyOne Health Plan is a Medicare Advantage plan. We are a provider-sponsored organization dedicated to providing exceptional coverage, customer service and access to high quality and cost-effective care.
We are a not-for-profit organization that is a part of the Trinity Network and are contracted with the Centers for Medicare & Medicaid Services (CMS) to participate in the Medicare Advantage program offering HMO products with, and without, Part D drug coverage to Medicare beneficiaries.
We are committed to partnering with our providers to build strong relationships and make working with us easier. We developed this manual to guide you through MercyOne Health Plan policies, procedures and processes. Great effort has been made to ensure the information in these pages is accurate. If there is any conflict between the contents of this manual and your provider agreement, the provider agreement will prevail. Please contact provider services if you have any questions.
Important News and Updates to this Manual
In accordance with your agreement, providers must abide by all provisions contained in this manual, as applicable. Revisions to this manual constitute revisions to MercyOne Health Plan's policies and procedures. Such revisions and other updates to policies and procedures may be communicated to network providers via the monthly Provider Update, but may also be communicated via multiple methods that may include mail, internet, email, telephone, and in person.
Provider Communications
We want to be a great partner and develop mutually beneficial partnerships with our providers. Communication is essential to successful relationships and sharing information with you is very important to MercyOne Health Plan. We distribute a monthly “Provider Update” to all our participating providers. It shares key information to stay current on matters that may affect your work with MercyOne Health Plan and our members.
How to Contact the Plan
Provider Service Center
Toll Free: 1-800-991-9907 (TTY: 711)
Toll Free Fax: 1-833-900-0607
8 a.m. to 5 p.m. Monday – Friday
Address
3100 Easton Square Place
Suite 300 – Health Plan
Columbus, Ohio 43219
Department Contact Information
Case Management
Toll Free: 1-800-240-3870, option 5
8 to 4:30 p.m. Monday – Friday
Toll Free Fax: 1-833-263-4870
Email: CaseManagement@MediGold.com
Compliance
Toll Free: 1-866-477-4661
Email: MediGoldCompliance@mchs.com
Contracting & Provider Relations
Toll Free: 1-800-991-9907 (TTY 711)
Toll Free Fax: 1-833-900-0608
Email: MediGoldContracting@mchs.com
Member Grievance and Appeals
Toll Free: 1-888-898-6129 (TTY 711)
Toll Free Fax: 1-833-802-2495
Member Services
Toll Free: 1-800-240-3851 (TTY 711)
Toll Free Fax: 1-833-900-0606
Pharmacy Benefit Manager
CVS Caremark Part D Services, LLC
P.O. Box 52066
Phoenix, AZ 85072-2000
Phone: 1-866-785-5714
Quality Management
Email: Quality@mchs.com
Risk Adjustment
Local Fax: 614-234-8728
Toll Free Fax: 1-833-978-1756
Email: riskadjustment@mchs.com
Special Investigations Unit (for reporting Fraud, Waste, and Abuse concerns)
Voicemail: 1-833-263-4863
Toll Free Fax: 1-833-900-0606
Email: SIU.MediGold@mchs.com
Anonymous: SIU Form
Utilization Management
Toll Free: 1-800-240-3870
Toll Free Fax: 1-833-263-4869
Stars and HEDIS
Toll Free Fax: 1-833-263-4823
Email: StarsAndHEDIS@mchs.com
TruHearing (for audiology and hearing aid services)
Toll Free: 855-286-0550
MediGold Vision (for vision services)
1-866-253-8963
8 a.m. to 8 p.m., seven days per week.
Additional Resources
Provider portal (for eligibility, claims and communications)
Essette Provider Portal (for all utilization management functions)
Member Evidence of Coverage documents