Questions? Contact Customer Service at (855) 645-8448
Provider Portal Available
Memorial Hermann Health Plan is excited to announce the launch of our new provider portal. We have several opportunities for training and assistance. Please visit the provider portal access and training page. Provider Portal Training | Memorial Hermann Health Plan
Have Questions? Meet with Provider Relations
The provider relations representatives are hosting scheduled appointment slots for providers. This provides an opportunity to meet 1:1 to discuss and review questions. They will be conducted via zoom. You can sign up for a slot by accessing the link below:
Sign Up for Provider Network Open Hours
Updated Prior Authorization Forms will be posted to the Health Plan website soon. A prior authorization request form should accompany both outpatient and inpatient service requests. To prevent processing delays, ensure that the prior authorization form accompanies your service request, and is complete. Incomplete authorization request forms will not be processed.
New Claims Address Effective 1/1/2023
Memorial Hermann Health Plan Claims
PO Box 19909
Houston, TX 77224
Eligibility: Please call customer service for eligibility at (855) 645-8448 on or after 1/1/2023.
2023 Claim Processing Notice:
Taxonomy Code Claim Submissions Required Field
| Memorial Health | Electronic Claims | CMS 1500 Form | UB-04 Form |
|---|---|---|---|
| Billing Provider Taxonomy | 2000A, PRV03 | Box 33b with qualifier ZZ | Box 81cc with B3 |
| Rendering Provider Taxonomy (required when Rendering Provider information is submitted at the claim and/or service line level) | 2310B, PRV03 | Box 24j with qualifier ZZ in 24i | N/A |
| Attending Provider Taxonomy (required on Inpatient Institutional claims) | 2310A, PRV03 | N/A | Box 76 with qualifier |
New Texas Gold Card law streamlines prior authorizations
Attention Behavioral Health Providers/Optum Network Providers
Attention Participating Provider: Required DSNP Training
Training is offered monthly in 2023, on every 4th Thursday @ Noon CST. Please email Provider Relations at providerservices@apex4health.com for registration.
Attention: Timely Filing Reminder
With the start of a new year, we want to remind you to submit claims within the timely filing requirements. We follow the claims submission requirements set forth in the Texas Department of Insurance regulations (95 days) for Commercial plans. We follow CMS guidelines (365 days) for our Medicare Advantage plan.
HMO Waiver of Liability Form
Appeal Reference Form
Change of Ownership Form
Request for Executed Agreement Authorization Form
Refund and Overpayment Reporting Form
Provider Change Form
PCP Change Form for Physician Offices
Sample UB Claim Form & Instructions UB-04
Sample Professional Claim Form & Instructions CMS 1500
Prior Authorization Form – Commercial Plans
Prior Authorization Form - MA Part C
Prior Authorization Form - Behavioral Health
2023 Prior Authorization Grid
Prior Authorization Requirements
2023 Prior Authorization Code List
2022 Prior Authorization Medical Statistics
Navitus Provider Portal
MA Formulary
MA Prior Authorization
Commercial Formulary
Commercial Prior Authorization
Memorial Hermann Specialty Pharmacy focuses on delivering high-quality, integrated care to help your patients achieve the best possible health:
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.
Learn more by visiting Memorial Hermann Specialty Pharmacy and by reading their Frequently Asked Questions.
Lumicera Specialty Pharmacy is another alternative specialty pharmacy benefit that we offer to our members. The process to fill a prescription is simple. Call a Lumicera Patient Care Specialist at (855) 847-3553 to get started.
Please go to the Lumicera Specialty Pharmacy Frequently Asked Questions page for additional resources.