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Update on COVID-19

In an effort to collaborate with our contracted providers and relieve administrative burden, MHHP has made the following decision:

Effective immediately, through April 30, we are suspending the prior authorization requirement for transfer from the acute hospital and subsequent admission to post acute facilities:

  • The receiving post acute facility may be a SNF, Acute Rehab facility or LTAC
  • The receiving post acute facility must be in network/contracted
  • To transfer to LTAC, it is expected that patients meet the CMS respiratory failure criteria (respiratory failure patients who have failed weaning and are at least 72 hours post trach with a reasonable expectation of functional clinical improvement)
  • To transfer to SNF or acute rehab, it is expected that patients meet CMS criteria for that level of care
  • Seven days of coverage will be provided to the SNF or ARF and five days of coverage for LTAC prior to the first utilization management review with the health plan. If the patient fails to meet criteria for ongoing care, the health plan will assist the post acute facility with discharge planning
  • The receiving post acute facility is expected to notify the health plan of the admission within two business days.

Should the COVID state of emergency continue after April 30, this decision will be reviewed and may be extended. This will be communicated on this website.

Does Memorial Hermann Health Plan cover the cost of COVID-19 testing for Members?

Memorial Hermann Health Plan will waive Member cost sharing including copays for all diagnostic testing for COVID-19. This policy will cover Members who meet CDC guidelines and have been ordered by a physician to be tested at an approved laboratory location. This policy is effective for all Commercial, Medicare Advantage and Hybrid members. Self-insured plan sponsors have the ability to opt-out of this policy at their discretion.

What CPT/HCPCS codes should be utilized for COVID-19 testing?

Memorial Hermann Health Plan is following the CMS coding guidelines for COVID-19 laboratory testing.

  • U0001 - 2019 Novel Coronavirus (2019-nCoV) Real-Time RT-PCR Diagnostic Panel should be used when specimens are sent to the CDC and CDC-approved local/state health department laboratories.
  • U0002 - 2019-nCoV Coronavirus, SARS-CoV-2/2019-nCoV (COVID-19), any technique, multiple types or subtypes (includes all targets), non-CDC should be used when specimens are sent to commercial laboratories and not to the CDC or CDC-approved local/state health department laboratories.

What other billing resources are available for COVID-19 testing?

The CDC (Centers for Disease Control and Prevention) issued guidance regarding COVID-19 effective February 20, 2020. For more information, click here.

Quest Diagnostics is also offering testing information for physicians and physician offices. Please check this website periodically for updates to stay up-to-date on developments. For more information, click here.

Are there other resources available to patients?

The CDC (Centers for Disease Control and Prevention) are providing updated information on a regular basis on their website for patients and other stakeholders. For more information, click here.

Introducing Memorial Hermann Specialty Pharmacy

Memorial Hermann Specialty Pharmacy focuses on delivering high-quality, integrated care to help your patients achieve the best possible health:

 

  • Knowledgeable, helpful staff to assist with specialty medications and prior authorizations
  • Timely and reliable delivery of specialty medications from the locally based pharmacy in Katy
  • Free delivery, regular refill reminders for patients and important updates
  • A pharmacy with a direct connection to Memorial Hermann providers, hospitals and clinics

 

Learn more by visiting specialtypharmacy.memorialhermann.org and by reading their Frequently Asked Questions.

Specialty Drug List

The Memorial Hermann Specialty Pharmacy Medication List is a listing by therapy of specialty medications that Memorial Hermann Specialty Pharmacy can provide or facilitate access and is subject to change. For more information about specialty medications, please visit Memorial Hermann Specialty Pharmacy.

Provider Portal

Our new Provider Portal is now available for use. To access the portal, please download and complete our Authorized User Access Request Form. For more information, including our User Manual and FAQs, read our Provider Portal Training resources.

Provider Manual

Provider Manual

Quick Reference Guides

HMO
PPO
Medicare Advantage HMO

Provider Forms

HMO Waiver of Liability Form
Appeal Reference Form
Provider Data Update Notification Form
Provider Online Access Form

Medical Management

Prior Authorization Form - Self Funded Plans
Prior Authorization Form - Fully Insured Plans
Medical Management Prior Authorization List
Prior Authorization Requirements
2019 Provider Notification of Changes

News and Updates

Facets System Upgrade - click here for more information.

Prior Authorizations Updates

Notices to Physicians and Providers

Memorial Hermann Health Plan, Inc., 929 Gessner, Suite 1500, Houston, Texas 77024, which provides group health maintenance organization (HMO) plans for persons living or working in the greater Houston area, is accepting applications as of February 1 through February 28, 2020, from physicians and providers (ancillary or facility) wishing to join the network as a participating physician or provider (ancillary or facility). Please contact us at ProviderServices@memorialhermann.org or contact number (713) 338-4801 to receive additional information about being a part of our HMO network.

Memorial Hermann Commercial Health Plan, Inc., 929 Gessner, Suite 1500, Houston, Texas 77024, which provides group health maintenance organization (HMO) plans for persons living or working in the greater Houston area, is accepting applications as of February 1 through February 28, 2020, from physicians and providers (ancillary or facility) wishing to join the network as a participating physician or provider (ancillary or facility). Please contact us at ProviderServices@memorialhermann.org or contact number (713) 338-4801 to receive additional information about being a part of our HMO network.

Memorial Hermann Health Insurance Company, 929 Gessner, Suite 1500, Houston, Texas 77024, which provides group preferred provider organization (PPO) plans for persons living or working in the greater Houston area, is accepting applications as of February 1, 2020 from physicians and providers (ancillary or facility) wishing to join the network as a participating physician or provider (ancillary or facility). Please contact us at ProviderServices@memorialhermann.org or contact number (713) 338-4801 to receive additional information about being a part of our PPO network.

Behavioral Health

Effective July 1, 2017, Memorial Hermann Health Plan (MHHP) will begin transitioning mental health and chemical dependency services to United Behavioral Health, operating under the brand Optum. Optum will be responsible for the professional provider and facility network, utilization management services and claims administration. Employer groups will transition to Optum on their renewal date. MHHP’s Medicare Advantage HMO and Medicare Advantage PPO plans will transition to Optum effective January 1, 2018. The behavioral health vendor information will be included on the member’s ID card for groups who have transitioned to Optum.

If you are interested in joining the United Behavioral Health network, please contact the United Behavioral Health Network Management Department at txbnsop@optum.com or 877-614-0484.

January 31, 2017 - Medicare Outpatient Observation Notice

On December 8, 2016, the Centers for Medicare & Medicaid Services (CMS) released the OMB-approved Medicare Outpatient Observation Notice (MOON). The MOON is mandated by the Federal Notice of Observation Treatment and Implication for Care Eligibility Act (NOTICE Act), passed on August 6, 2015. The MOON is a standardized, written notice explaining that a Medicare beneficiary, including a Medicare Advantage enrollee, is receiving outpatient observation services, and is not an inpatient.

The notice must include the reasons the individual is an outpatient receiving observation services and the implications of receiving such services. Hospitals and critical access hospitals (CAHs) must deliver the notice no later than 36 hours after initiation of observation services. All hospitals and CAHs are required to start providing this statutorily required notification no later than March 8, 2017. Medicare Outpatient Observation Notice and accompanying form instructions are available by clicking here.

September, 2015 - ICD-10 Transition

The transition to ICD-10 will be implemented on October 1, 2015. Please read this letter from CMS regarding the transition. You may also visit CMS.org and the American Medical Association for more information on the transition.