Questions? Contact Customer Service at (855) 645-8448
New Claims Address Effective 1/1/2023
Memorial Hermann Health Plan Claims
PO Box 19909
Houston, TX 77224
Coming in 2023 - New Core Operating System
Effective 1/1/2023, Memorial Hermann Health Plan will be updating its core operating system. Providers will experience minimal changes, offering a more robust and efficient provider experience. We do not expect any disruption during implementation. We encourage providers to check the resource page and announcements monthly to stay up to date on new communications.
Provider Portal Eligibility: Please call customer service for eligibility at (855) 645-8448 on or after 1/1/2023. Due to the transition to our new core operating system, all members will show a 12/31/2022 termination date in the provider portal which may be inaccurate
2023 Claim Processing Notice:
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.
2023 Notice to Physicians and Providers:
Memorial Hermann Commercial Health Plan, Inc., PO Box 19909, 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, 2023, 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@apex4health.com or contact number (800) 429-6396 to receive additional information about being a part of our HMO network.
Memorial Hermann Health Insurance Company, PO Box 19909, 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, 2023 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@apex4health.com or contact number (800) 429-6396 to receive additional information about being a part of our PPO network.
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
2022 Prior Authorization Grid
2023 Prior Authorization Grid
Prior Authorization Requirements
2022 Prior Authorization Code List
2023 Prior Authorization Code List
2021 Prior Authorization Medical Statistics
New Provider Portal is here! For more information see the Provider Portal Announcement, FAQ, or Provider Portal training deck. Still have questions? Sign up for a personalized training session. Submit your request today at Provider Portal Training Request, use password MHHP2022Portal to access schedule.
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.