Claims and Provider Reimbursements

The forms and information available here will help you file claims to the appropriate addresses and facilitate your reimbursements. If you need further information, please visit the Contact Us page for assistance.

Claims

Out-of-Network Commercial Claims Submission

Out-of-network providers may submit claims to:

Global Care
PO Box 247
Alpharetta, GA 30009
Phone: 800.860.1111

Or file electronically:
Payor ID: 07689
Payor Name: PHP

Out-of-Network Provider Reimbursements

Out-of-network providers are reimbursed in accordance with the Zelis/Global-Care Network leased pricing, as applicable, or per PHP's Out of Network standard reimbursement schedules.  In keeping with the Centers for Medicare and Medicaid (CMS) reimbursement methodologies for the mid-Michigan region, PHP's Out of Network standard reimbursement schedules are a reasonable and customary charges standard.  PHP may review and adjust these reimbursement schedules on a yearly or as Market determines basis.  

Provider Appeals

PHP and Sparrow PHP have processes for documenting and responding to administrative complaints, including claim payment decisions. Claim payment disputes may be submitted in writing by mail or fax:

PHP
Attn: Provider Appeals
PO Box 30377
Lansing, MI 48909-7877

Fax: 517.364.8411
Attn: Provider Appeals

PHP will research all claim payment disputes and provide a response within 30 days of receipt.  Appeals must be received within 90 days from the date of adverse determination and/or date the claim was processed.  

Provider Check Schedule

PHP processes provider checks for all products every Monday and Thursday, as well as on the last business day of the month. If you have any questions regarding the check-writing schedule, please contact your Provider Relations Team.