Providers

PHP and Participating Providers: Partners in Health

Physicians Health Plan (PHP) and its participating providers share a commitment to ensuring the health and well-being of PHP members. To help achieve our common goal, PHP is committed to providing you with quality, efficient service. In this section, you will find information about partnering with PHP – our policies and procedures, important forms and answers to frequently asked questions

Important Information Regarding the PHP Behavioral Health Fee Schedule

Effective April 1, 2019. Learn More

Important Information Regarding the PHP Standard Fee Schedule

Effective April 1, 2019. Learn More

Important Notice Regarding Remark Code N04

Physician’s Health Plan has recently become aware that codes 97793, 99151, 99203, 99495, and 99496 are denying inappropriately with remark code N04 “This service is considered a part of the original surgical procedure”. The issue has been corrected and adjustment projects have been submitted, please allow up to four weeks for claims to reprocess. If you feel that additional claims have denied inappropriately with remark code N04, please reach out to the Provider Relations team at PHPProviderRelations@phpmm.org. We are sorry for any inconvenience that this has caused, and we are working diligently to capture all affected claims and to ensure this does not happen again in the future.

Primary Care Incentive Program Report Is Now Available

2019 Provider Incentive Reports are available for PCP's who qualify for PHP's 2019 Primary Care Incentive Program. The reports are available for each qualifying physician which includes the list of members qualifying for each measure. Reports will be available the beginning of ever month. Learn More

Important changes to Facet Injections and Facet Neurotomy - Effective Oct. 1, 2018

Effective Oct. 1, 2018 prior approval is required for all dates service, replacing past practice of requiring prior approval at the fourth date of service. Learn More

Struggling with Chronic Pain?

Physicians Health Plan invites PHP members to participate in a 6-week workshop called Chronic Pain PATH. Learn More

New Opioid Utilization Management starting July 1

New opioid utilization management strategy starting July 1, 2018, in conjunction with Michigan Senate Bill 274. SB 274 requires that prescribers “cannot prescribe more than a 7-day supply of an opioid within a 7-day period if treating a patient for acute pain.” More details to come.

For more information on Senate Bill 274 and other Michigan opioid prescribing provisions go to the: Michigan State Medical Society.

Opioid Member Flyer

Scam Alert: Extortionists Targeting DEA Registrants

It has been brought to our attention that there is a new scam targeting DEA registrants. Criminals are contacting DEA registrants and demanding money and threatening to suspend the registrant’s DEA license if demands are not met. These calls will show on caller ID as originating from the DEA Registration Support 800 number. Please be aware that a DEA employee will never contact a registrant with these demands. The DEA is aware of this scam and ask that you contact them at: https://www.deadiversion.usdoj.gov/pubs/pressreleases/extortion_scam.htm or call 1.800.882.9539, to report any criminal activity related to this matter.

PHP's Adult ACA Wellness Visit Program Outbound Calls

Part of PHP's Adult ACA Wellness Visit Incentive Program is to conduct outreach calls to members in ACA-compliant plans to assist them in choosing a Primary Care Provider and scheduling an appointment.

Beginning April 2, 2018, SPHAnalytics (SPHA) will begin conducting outbound calls to PHP Members in ACA-compliant plans. The outbound call will consist of helping the Member obtain a Primary Care Physician (PCP) and scheduling a Wellness Visit. The representative from SPHA may contact your office with the member on the phone to help schedule a Wellness Visit. It's important for all PHP members to have an annual Wellness Visit and we appreciate your cooperation. If you have any questions, please contact your Provider Relations Team at 517.364.8316 or 517.364.8323 or send email inquiries to PHPProviderRelations@phpmm.org 

Timely filing limit changes

Important changes are coming to Physicians Health Plan’s (PHP) requirements for submitting claims. Learn more. 

Electronic Funds Transfer (EFT)

Physicians Health Plan (PHP) is excited to announce that you are now able to receive your PHP payments electronically! Learn more. 

New provider portal MyPHP launches

MyPHP is a unique online tool for accessing benefit, eligibility, and claims data. Learn more. 

General Forms and Information

Please click on the link below to access forms and information, including: appeal forms, claim forms, credentialing forms, out-of-network authorization request form, medication prior authorization forms, and the medication drug list.

 


General Forms and Information

Provider Manual

PHP’s Provider Manual details what you need to know when caring for a plan member. It contains information regarding PHP products, medical resource management and quality improvement programs, billing and claim procedures, ID cards and eligibility verification. The procedures and descriptions of health benefit plans outlined in this manual are intended to cover most contracting situations you and your office staff will encounter. Please note: To the extent that any provision in your participation agreement differs from the requirement(s) described in this manual, the provisions of your participation take precedence.

 

Provider Manual