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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.
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 until further notice 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.
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.
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.
Prior Authorization Form - Self Funded Plans
Prior Authorization Form - Fully Insured Plans
Prior Authorization Form – MA Part C
2020 Medical Management Prior Authorization List
2021 Medical Management Prior Authorization List
Prior Authorization Requirements
2019 Provider Notification of Changes
Attention All Primary Care Physicians:
Effective January 1, 2021, all Memorial Hermann Health Plan Medicare Advantage members will need to select a primary care physician (PCP). For more information, see Primary Care Physician Notification.
New Prescription Benefit Manager
Memorial Hermann Health Plan is making a change effective January 1, 2021 to Navitus Health Solutions, LLC to be our new prescription benefit manager (PBM). For additional information, see Prescription Benefit Manager Notification.
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, 2021, 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, 2021 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.
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.