MHP requires that the benefit design maintain at least a 15% incentive differential (steerage) between utilization of in-network versus out-of-network providers. Steerage less than 15% can be considered if there are other areas of the plan that adequately incent the employee to use MHP providers. All benefit plan designs being proposed should be sent to MHP for review.
MHP requires notification of the utilization review program including precertification requirements, company name and phone number.
MHP provides an annual directory of providers (with periodic updates) for each employee who accesses the network. An on-line provider directory can be accessed through this web site.
The ID cards should contain, at a minimum, the following elements: (1) MHP logo, (2) claims submission address, (3) phone numbers for eligibility and utilization review. MHP can provide network logo stickers to be affixed on the front of the card or camera ready artwork for logo imprinting. The correct information follows:
P.O. Box 23908
Jackson, MS 39225-3908
Payor ID# 64068
Benefit Plan Design
MHP notifies all provider offices of new groups that access the network. Final plan design should be forwarded to MHP as early as possible prior to the effective date. In most cases, an employee benefit booklet will suffice.
Employee Orientation Meetings
MHP encourages its participation in any employee orientation meetings that may be scheduled so that we can accurately answer any questions related to the MHP network. MHP has available marketing materials and provider directories which may be distributed.
Explanation of Benefits (EOB)
Standard EOB information requirements include: 1) covered person’s name, 2) date of service, 3) billed amount by CPT-4 code number for physician charges and standard nomenclature for hospital charges, 4) the amount of the allowable charge based on applicable fee schedule, 5) the amount of benefits paid pursuant to the Plan, and 6) the balance due from the covered person for services furnished by the MHP provider. The EOB should clearly reference negotiated rates to the MHP network.
Claims Administration by Hospital DRGs
MHP facilities usually incorporate a DRG payment methodology for inpatient services. Claims administration of DRGs (vs. billed charges) is required.