Resource Center

Questions? Contact Customer Service at (877) 364-2789

Resource Center

Read the provider manual, download and print forms, see our latest newsletters, and receive latest updates from Health Plan from our one-stop resource center. 

Prior Authorization – Post COVID

As Memorial Hermann Health Systems begins to reopen suspended elective and non-urgent/non-emergent healthcare services, MH Health Plan has made these modifications to the current prior authorization process:

  1. Authorizations for diagnostics, procedures, surgeries and other health services for dates of service March 13, 2020 to May 15, 2020 will be honored through December 31, 2020.
  2. These authorizations will be extended in our system and new authorization letters will be sent to members and providers.
  3. Providers are strongly encouraged to validate member eligibility before performing the service.
  4. If the proposed date of service is beyond December 31, 2020 please contact the MHHP Prior Authorization department so that the correct date can be entered.

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.

Are there any medical-related Benefit Cost Share updates?

All cost-shares and co-pays associated with COVID-19 diagnostic testing will be waived regardless if the doctor is IN or OUT of network. Telemedicine will be paid at 100% for all plans. These updates will be in effect through December 31, 2020, and we will reevaluate each month accordingly.

Are there any Pharmacy updates?

The “Refill Too Soon” and DUR edits (DUPRX and DUPTHERAPY - overrides soft and hard edits under DUR) for all groups will continue to be lifted until the Federal and/or state declaration of emergency is in place. For Medicare Advantage, Pharmacy team has relaxed the refill-too-soon edits. These changes require the discretion of the dispensing pharmacist at point of sale. An override code submitted by the pharmacist might be required at the retail level for an early refill to process.

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 Memorial Hermann Specialty Pharmacy 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
Prior Authorization Form – MA Part C
Medical Management Prior Authorization List
Prior Authorization Requirements
2019 Provider Notification of Changes

News and Updates

Facets System Upgrade

Claims Editing Software Update
Effective 5/29/2020, Memorial Hermann Health Plan will be updating its claims editing software. As a result of the change, providers may notice new or different explanation code descriptions on explanations of payment or electronic remittance advice statements that are more descriptive.  We do not expect any disruption during this implementation and thank you for patience.  If you have any questions during this time, please contact Customer Service at (855) 645-8448.

Prior Authorizations Update

Providers/Physicians may request the renewal of an existing prior authorization for a service/treatment at least 60 days before it expires. Memorial Hermann Health Plan must issue a determination before the current prior authorization expires.

2020 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, 2019, 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.

Back to top ^