Providers

As you know, UM Health Plan is winding down operations as of Dec. 31, 2025. The closure has implications for the processing of claims, provider appeals, and prior authorizations for commercial members.

Claims: Please submit claims promptly, using the address on the back of the member ID card and in the Provider Manual. Timely submission will help ensure payments are issued smoothly while we prepare to close.

Provider Appeals: Effective April 1, 2025, providers will have 60 calendar days* from the date of the adverse benefit decision letter or the date of the initial claim denial to submit an appeal. This policy change shortens the timeline for appeals, so please plan accordingly and use the Provider Appeal Form.

*This policy change does not affect the Medicare appeals process.

Prior Authorizations: Please follow appropriate protocols to request necessary authorizations before providing medical services. Providers are required to use EZ Auth/Referrals to submit authorization requests electronically.** You can access EZ Auth/Referrals through your provider portal.

**Providers are able to submit PA request forms for Self-Funded Members only. This policy does not affect Medicare.

Thank you for your continued partnership. We remain committed to the health of our members and appreciate your assistance with prompt submission of claims, appeals, and prior authorizations.

Please click here for a PDF version of the official letter.

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UM Health Plan has completed the annual review of our standard fee schedule for 2025. UM Health Plan standard fee schedules will remain market competitive and align with reimbursement within our service area.

The 2025 standard fee schedules will be available no later than April 1, 2025, and can be obtained by logging into the UM Health Plan provider portal. Once logged into the provider portal, you will select “Standard Fee Schedules” within the “Quick Access” box or by selecting “Office Management” in the toolbar and selecting “Standard Fee Schedules.” If you need assistance logging into the provider portal, please email ProviderRelations@UofMHealthPlan.org.

Please click here for a PDF version of the official letter.

The 2025 Primary Care Management Incentive Program information is now available. Please log into your Provider Portal and click on "Provider Incentive Program" in the Quick Access section to learn more.

University of Michigan Health Plan (UM Health Plan) is committed to improving the health of individuals, families, and communities. As part of this commitment, UM Health Plan participates annually in Healthcare Effectiveness Data and Information Set (HEDIS). HEDIS is a standardized set of performance measurement criteria that relies on medical claims data and medical record review. UM Health Plan requires the assistance of our network providers to obtain the required medical record information for the HEDIS measurement year (MY) 2024 review.

The HEDIS MY 2024 audit process will be conducted between Feb. 2025 and May 2025. If medical record information is needed for health plan members under your care, your office or facility will be contacted directly by a Medical Record Review nurse to verify that record(s) exists and to make arrangements for obtaining the necessary information. Arrangements for data collection may include on-site chart reviews. During on-site reviews, the reviewer is required to copy any relevant portions of the medical chart(s) as required by our auditing firm. If an on-site review is not optimal, the reviewer will work with your office to identify both an efficient and most secure method for the transfer of requested information. UM Health Plan appreciates your assistance and cooperation in meeting requested timelines and providing medical record information. 

HIPAA Privacy Regulations

Under HIPAA requirements, HEDIS data collection is a quality assessment and improvement activity and is therefore included in the definition of health care operations and may be provided to UM HealthPlan without authorization from members.

If you have any questions or concerns about the HEDIS medical record data collection process, please call Shelly Marsh, Quality Audit Manager, at 517-364-8400. UM Health Plan appreciates the excellent care you provide to our members, and thanks you in advance for your help during the HEDIS MY 2024 audit process.

Effective Dec. 6, 2024, the UM Health Plan ePayment Center portal URL will be changed to UofMHealthPlan.ePayment.Center. The current URL of PhysiciansHealthPlan.ePayment.Center will no longer be accessible. All current functionality will remain the same.

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Beginning Dec. 1, 2024, UM Health Plan will require all providers to utilize EZ Auth/Referrals for medical prior authorization*. EZ Auth/Referrals allows you to submit authorization requests electronically and receive an immediate response for the authorization status. While many Providers in the UM Health Plan network are already utilizing EZ Auth/Referrals, UM Health Plan invites you to attend a virtual training session outlining how to use EZ Auth/Referrals portals.

See the EZ Auth/Referrals User Guide here.

Click here to select a date and register for one of the virtual training sessions.

*This does not impact UM Health Plan Self-Funded members

Effective Jan. 1, 2025, University of Michigan Health Plan (formerly Physicians Health Plan) is changing its pharmacy benefit manager (PBM) from CVS Caremark to Express Scripts, Inc. (ESI).

See here for more details.

Effective immediately, University of Michigan Health Plan (UM Health Plan) is accepting electronically submitted claim adjustments and voids. Click here to see more information.

In October 2024, UM Health Plan will be partnering with Zelis Payment Integrity Solution to implement a new payment integrity platform for code editing and expert claim review (ECR). Please see the flyer for details.

Physicians Health Plan (PHP) is rebranding to University of Michigan Health Plan to better align with our majority owner - University of Michigan Health. University of Michigan Health owns 90% of the health plan; Covenant HealthCare owns 10% of the health plan. The rebrand will launch in phases beginning Aug. 30, 2024. See here for more info.

To remain compliant with CMS, State, and Federal guidelines, we require prompt notification if a PHP practitioner is no longer accepting new patients. You are required to complete the Provider Information Update Form and return it to us in one of the following ways. Thank you for your adherence to this policy.

‍Mail:    

University of Michigan Health Plan
Attn. Network Services
PO Box 30377
Lansing, MI 48909

Fax:     517-364-8412

Email:  ProviderUpdates@UofMHealthPlan.org