MMBA
Mid-Michigan Chapter
April 3, 2013
Visit Us Online at McLarenHealthPlan.org or McLarenHealthAdvantage.org
Service Area
McLaren Health Plan
Commercial
McLaren Health Plan
Medicaid
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Increased Reimbursement!
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Opportunities
 Did you know that you can easily turn a sick visit into
a well child visit?
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When you have a MHP member in your office for a sick visit
who is also due for a well child visit, simply incorporate the
elements of a well child exam into the visit, and bill MHP for
both the sick and well child services performed
You can do this by adding modifier 25 to the sick visit and
you will be reimbursed for both services
 As
another way of ensuring that our members receive
this important well child exam, MHP will reimburse
you for one well child visit each calendar year. You
don’t have to wait a full calendar year to perform a
well child visit
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Club 101

Well Child Visits for Medicaid Members
 McLaren Health Plan reimburses Providers higher than the Medicaid
fee schedule
 Well child visit codes are now reimbursed at $101.00 per visit
 Includes CPT Codes 99392, 99393, 99382, and 99383
 Well child visits must include:
 Physical exam
 Mental and Developmental screening
 Hearing and Vision components
 Other tests to detect potential problems
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Expanded Access Award

Expanded Access for Commercial and Medicaid Members
 Provide service to a McLaren Health Plan member in the office
during hours other than normal business hours and receive an
additional $17.38 in reimbursement
 Includes CPT Codes 99050 and 99051
 Medicaid does not currently reimburse providers for either of these
codes. This is additional reimbursement offered by McLaren Health
Plan.
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Lead Testing Incentive

Lead Testing for Medicaid Members
 This lead screening program is easily achievable and recognizes
McLaren Health Plan’s Primary Care Physicians who meet MDCH
requirements of lead testing children before their second birthday
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CPT 36416 – Collection of capillary blood specimen for lead - $15.00
CPT 83655 – Perform the lead testing in office - $25.00
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Customer Service

Provider Questions

Call Toll Free (888) 327-0671
 Answered by a Specialized Customer Service Representative
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Choose Benefit/Eligibility Question Option for Member Eligibility and Benefit
Verification or Referral Assistance
Choose Claim Status/Question for Claims Inquiries
Office Support

Each Office is Provided a:
 Network Development Coordinator
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Contract Questions
Office Orientations
Education
Requests for Materials
Nurse Case Manager (PCP Offices)
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Each Office has an Assigned Nurse
Medical/Clinical Issues Support
Member Issues Requiring Follow-Up
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Website Information
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McLarenHealthPlan.org
McLarenHealthAdvantage.org
 Key Information
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Provider Directories
Formularies
Disease and Health Management Programs
Clinical/Preventive Practice Guidelines
Provider Manual
Provider Newsletters
FACTSWeb
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Real-time, on-line access to insured and dependent eligibility,
plan summary information, claims history and status, and
payment reports
Requires completion of password application for access to this
program
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Key Contacts
(Hours of Operation: Mon. – Fri., 8:30 AM – 5:00 PM)

Customer Service:
(888) 327-0671

Network Development:
(888) 327-0671
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Medical Management:
(888) 327-0671
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Mailing Addresses:
Administrative
G-3245 Beecher Rd
Flint, MI 48532
Claims
PO Box 1511
Flint, MI 48501-1511
EDI Claims
Optum ENS
Visit Us Online at McLarenHealthPlan.org or McLarenHealthAdvantage.org
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Visit Us Online at McLarenHealthPlan.org or McLarenHealthAdvantage.org
MHP41061043