Introduction

On this page:

About Mount Carmel MediGold Health Plan

Mount Carmel MediGold 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 Mount Carmel MediGold 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 Mount Carmel MediGold 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 Mount Carmel MediGold 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 Mount Carmel MediGold 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.