Providers

Welcome! Here you will find useful resources such as guidelines and procedures, our provider directory and other forms and documents.  We also provide access to online member eligibility and claims information.

The downloadable files below are viewable using Adobe's free Acrobat Reader.

Interested in becoming a provider? Call Gary Francis at (313) 871-7805.

Need Help Finding a Specialist? If you need assistance in locating a specialist for evaluation and treatment of a member, please contact Mae Martin at (313) 871-7898.

Need an update on credentialing status? To ensure the quality of health care delivery to its members, Total Health Care recredentials participating providers every three years according to the standards set forth by the National Committee for Quality Assurance (NCQA).

If at any time a provider wishes to inquire about his/her credentialing status or review information obtained during the recredentialing process, s/he may do so by contacting the Credentialing Department at (313) 871-6583.

Log in to the Provider Portal

Important Announcements

EFFECTIVE 10/1/2011 **NEW PHARMACY BENEFIT MANAGER-CATALYST RX**

MSA POLICY BULLETIN 10-26 NATIONAL DRUG CODE REPORTING

NDC-HCPCS CROSSWALK

PHYSICIAN ADMINISTERED DRUG NDC CODES

OIG HEAT Provider Compliance Training

IMPORTANT VISION ANNOUNCEMENT FOR COMMERCIAL MEMBERS (Effective 6/1/10)

Effective July 1, 2010 all referrals issued by the PCP offices must be submitted electronically, handwritten referrals will no longer be accepted and will result in a denial of the claim.

HEALTH INFORMATION TECHNOLOGY UPDATE: The American Reinvestment and Recovery Act (ARRA) of 2009 establishes a program for payment to Medicare and Medicaid providers who adopt and become meaningful users of electronic health records (EHRs). Medicaid Eligible providers must meet the following requirements:

• Eligible Professionals: Non-hospital based with at least 30% Medicaid volume
• Physicians
• Dentists
• Certified Nurse Mid-wives
• Nurse Practitioners
• Physician Assistants (PA) practicing in a PA-led FQHC or Rural Health Clinic

See the following information for forums and background information prepared by MCEITA, the Michigan Center for Effective IT Adoption.

• Michigan_Health_IT_Forums_Postcard
• M-CEITA Overview Handout
• M-CEITA Incentives Handout
• CMS EHR Incentive Program

Electronic Prescribing

NOTICE TO THERAPY PROVIDERS
Please Note: You must obtain authorization for therapy services from Integrity Rehabilitation.  The referral you have received from the member’s PCP is valid only for the evaluation. You may fax the authorization request to (810) 534-5037 or e-mail the authorization to THC@integrityrehabservices.com”

Check out www.MichiganHealthIT.org for the latest health IT news and initiatives including Medicaid EHR Incentive program, MiHIN , HIE initiative and M-CEITA.

Provider Manual

• Provider Manual
• Provider Manual Attachments

Provider Directories

• Provider Directory - Physician Preferred
• Provider Directory - Commercial
• Provider Directory - Medicaid
• Provider DIrectory - MIChild

Pharmacy - Prior Authorization Forms

Documents in this section are appropriate for both Commercial and Medicaid lines and must be completed by the prescribing physician.

• Prior Authorization Form
• Plavix Authorization Form
• Specialty Pharmacy Information
• Specialty Pharmacy Prior Authorization Form

Total Health Care Guidelines

• Bariatric surgery
• Michigan Quality Improvement Consortium (MQIC) Guidelines
• Preventing Domestic Violence: Clinical Guidelines on Routine Screening
• Weight Management
• Attention Deficit Hyperactivity Disorder (ADHD) Guideline

Provider Newsletters

• Provider Connection - Winter 2010
• Provider Connection - Fall 2010
• Provider Connection - Summer 2010
• Provider Connection - Spring 2010

Downloadable Forms

Profile Page

Authorization for Therapy Services

Immunization Incentive Form

LEAD Incentive Form

MSA-4240 Certification for Induced Abortion

MSA-1550 Beneficiary Verification of Coverage

MSA-2218 Acknowledgement of Receipt of Hysterectomy Information

MSA-1959 Informed Consent to Sterilization

MAHP Credentialing Application 2004

Other Documents

Authorization/Prior Authorization Requirements

Medications Requiring Prior Authorization

Claims Processing Procedures

Participating Hospital Provider ID Numbers

Member Rights and Responsibilities

Provider Appeal Process

Medicaid Arbitration

Improving Practitioner-Patient Communication