Frequently Asked Questions
Answers to commonly asked questions about the credentialing and claims processes are provided below.
Do you credential physician assistants, CRNAs or nurse practitioners?
PHP does not credential physician assistants or CRNAs. PHP does credential nurse practitioners who have a master’s degree in nursing and are board certified. Nurse practitioners also require a collaboration agreement with a physician in their practice.
Why do I have to complete the Disclosure Addendum?
This information is required by the State of Michigan and must be on file to complete each credentialing and recredentialing application. A PHP credentialing coordinator will go to a state website to perform a search by name and/or social security number to determine if an individual has any criminal history with Medicaid or Medicare. The addendum will require the signature of the individual practitioner undergoing the credentialing or recredentialing process.
Am I required to have admitting hospital privileges?
Hospital-admitting privileges are required for most specialties. If you do not have admitting privileges at a participating PHP hospital, you must make arrangements with another participating practitioner within your specialty to handle admissions. This arrangement needs to be in writing and signed by the individual willing to provide this service. Contact a PHP credentialing coordinator to determine if your specialty requires hospital privileges (and, if so, whether you are able to use a designee) and to obtain a current list of participating hospitals.
What do I need to include in the credentialing application packet?
A copy of your DEA certificate and professional liability, a completed application and – for solo practices – a signed contract.
What are your requirements to be a participating provider with PHP?
The practitioner needs to be residency trained or board certified in the specialty in which he or she is applying.
What are the minimum professional liability limits?
Limits depend on the specialty. Please contact a credentialing coordinator for further information at 517.364.8312
How can I check the status of my application?
Applicants have the right to be informed of the status of their application. Request for status may be in writing or by calling PHP at 517.364.8312
What services/procedures require prior authorization? How do I check eligibility and claim status?
Providers can check eligibility and claim status by signing up for the MyPHP Provider Portal
I am a non-network provider. Where do I send claims?
Submit your claims to the following address:
Where can I find the most recent provider directory?
Please review the PHP Provider Directory 800.832.9186 800.661.8299
What do I need to do if I need to change our office address, name, phone number, etc.?
Your office will need to submit a Provider Information Update Form
Does PHP release fees?
PHP does release fees, but we ask that you please contact your provider relations coordinator directly at PHPProviderRelations@phpmm.org
Can I get training for my staff, and what type of training is available?
PHP does provide training and new provider orientation either in your office or at PHP. Please access the Training Opportunities
Does PHP have a provider manual?
Review the latest Provider Manual