Resource Center

Questions? Contact Customer Service at (855) 645-8448

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.

News and Updates

New Provider Portal
Effective 9/20/2021 all providers are able to access the new provider portal by self-registering. Please email the portal support team at MHHPProviderPortal@memorialhermann.org for access to one of the training sessions listed below. The email should include name and contact information of attendee, provider/group/facility name, tax ID, and NPI with preferred time slot. For more information see the Provider Portal section of this page.

  • 9/16/2021 @ Noon
  • 9/17/2021 @ Noon
  • 9/20/2021 @ Noon
  • 9/21/2021 @ Noon

New Credentials Verification Organization
Memorial Hermann Health Plan has partnered with Symplr to be the new Credentials Verification Organization (CVO) for all contracted providers, effective 7/1/2021. NCQA certified, Symplr provides expert credentialing and licensure application services that align with Memorial Hermann Health Plan’s desire to provide a positive provider experience. If you are in the process of recredentialing proceed based on the request. If you have questions regarding this transition, please call us at (855) 645-8448 or email Provider Relations at providerservices@memorialhermann.org.

  • Launch and Processing of Credentialing Applications
  • Notifications regarding recredentialing
  • Processing of recredentialing applications
  • Delegation Audit

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.

New Specialty Pharmacy Services
In 2021, Memorial Hermann Health Plan members have two convenient options to fill their specialty pharmacy prescriptions. The specialty medications must be filled at Memorial Hermann Specialty Pharmacy or at Lumicera Health Services.

To learn more about Memorial Hermann Specialty Pharmacy. Please visit Memorial Hermann Specialty Pharmacy and by reading their Frequently Asked Questions. The Memorial Hermann Specialty Pharmacy Medication List can be found here.

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. Provider enrollment forms can be found here.

Provider Manual

Provider Manual

Quick Reference Guides

HMO
PPO
Medicare Advantage HMO

Provider Forms

HMO Waiver of Liability Form
Appeal Reference Form
Change of Ownership Form
Request for Executed Agreement Authorization Form
Refund and Overpayment Reporting Form
Provider Data Update Notification Form
PCP Change Form for Physician Offices

Medical Management

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

Provider Portal

New Provider Portal is here! For more information see the Provider Portal AnnouncementFAQ, or Provider Portal training deck. Still have questions? Email MHHPProviderPortal@memorialhermann.org for additional assistance.

Provider Portal

Pharmacy

Navitus Provider Portal
MA Formulary
MA Prior Authorization
Commercial Formulary
Commercial Prior Authorization 

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

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.

Additional Specialty Services

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.

2021 Notices to Physicians and Providers

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.

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