Notices Archives

Effective 07.01.2024, UM Health Plan is excited to share that ABA services can be entered through the EZ Auth/Referrals application. The application allows you to submit authorizations electronically and get an immediate response for the authorization status. In addition to the enhancement, PHP will also be standardizing the criteria. To learn more click here.

Physicians Health Plan (PHP) is excited to announce improvements to our claims processing system which allows submission of claims electronically when it is determined that another Payor is primary. This change is effective immediately. For more information click here

Click here to find updates from UM Health Plan regarding the CHC cyber security incident. This bulletin addresses PHPs impact on claim submission, claims processing and payment and post payment auditing

UM Health Plan is providing Information to help providers check members’ eligibility and submit claims if you use CHC clearinghouse to conduct EDI transactions. Learn More

PHP is hosting a free Diabetes-PATH workshop via Zoom on Tuesdays, March 12 – April 16, 2024, from 6-8:15 pm. The workshop offers information on healthy eating, how to make meal plans, fitness and exercise, preventing complications, monitoring blood sugar, relaxation techniques, and much more. This is a wonderful opportunity to learn valuable information about living with and managing diabetes from the comfort of your own home. Please see attached flyer for more information.

Please review the provider registration flyer for instructions. You will need to register for a new account, even if you previously had a MyPHP portal account. Your current login credentials will not work for the new portal.

Please remember to designate one Local Administrator for your office and have that individual register for the new provider portal. Once PHP confirms this individual, they will be able to add other users from your organization, including additional Local Administrators.

PHP is hosting a free Diabetes-PATH workshop via Zoom on Tuesdays, March 12 – April 16, 2024, from 6-8:15 pm. The workshop offers information on healthy eating, how to make meal plans, fitness and exercise, preventing complications, monitoring blood sugar, relaxation techniques, and much more. This is a wonderful opportunity to learn valuable information about living with and managing diabetes from the comfort of your own home. Please see attached flyer for more information.

Physicians Health Plan (PHP) is providing Information to help providers check members’ eligibility and submit claims if you use CHC clearinghouse to conduct EDI transactions. Learn More

Click here to find updates from PHP regarding the CHC cyber security incident. This bulletin addresses PHPs impact on claim submission, claims processing and payment and post payment auditing.

Physicians Health Plan and PHP Medicare are moving to 1301 N. Hagadorn, Ste 1E, East Lansing, MI 48823 in Jan. 2024. You can visit our new location beginning Tuesday, Jan. 16, 2024. Parking is available off Hagadorn.

We will remain at 1400 E. Michigan Ave. through Jan. 15, 2024.

All PO boxes, phone, and fax numbers, email addresses, and office hours will remain the same.

Physicians Health Plan (PHP) recently mailed the Q4 Provider Connection to the PHP Network. It has been identified that a mailing label issue has occurred which has potentially caused your office to receive the Provider Connection at the correct address, but potentially with a different Provider Group Name or Provider name to appear on your mailing. We want to assure you that your demographic data with PHP was not changed. We apologize for any confusion this may have caused.

The 2024 Primary Care Incentive Program communication and technical guide are now available. Access the MyPHP Provider Portal and select Provider Incentive Program in the Quick Access section to learn more.

Physicians Health Plan (PHP) previously announced the launch of a new provider portal effective Oct. 9, 2023. The launch of the new provider portal has been postponed to Oct. 23, 2023.

Please review the provider notification for more information.

Our new portal features many of the same features as our previous portal, including:

• View Referrals
• Search for a Patient
• View Claims
• Find a Form
• Send a Message
• And more!

You can find the new portal by visiting PHPMichigan.com/MyPHP and selecting Provider Portal.

You will need to register for a new account after the launch on Oct. 23, even if you previously had a MyPHP portal account. Your current login credentials will not work for the new portal. The current portal will close on Oct. 23, 2023.

The PHP Medicare portal will be accessed through a link inside the new portal. A one-time validation will be required.

Thank you for participating with PHP. If you have any questions, please contact PHP Provider Relations by emailing PHPProviderRelations@phpmm.org.

PHP is hosting a free Diabetes PATH workshop via Zoom on Wednesdays, Sept. 27 – Nov. 1, 2023, from 6 - 8:15 p.m. The workshop offers information on healthy eating, how to make meal plans, fitness and exercise, preventing complications, monitoring blood sugar, relaxation techniques, and much more.

This is a wonderful opportunity to learn valuable information about living with and managing diabetes from the comfort of your own home. Please see attached flyer for more information.

Payment for the 2022 Primary Care Incentive Program is now being issued, if an incentive bonus was achieved. The final report and provider notice can be accessed within the MyPHP Provider Portal.

Effective July 1, 2023, prior authorization (PA) for PT and OT is no longer required for City of Lansing plans. See the City of Lansing PA for PT and OT flyer for more information.

On Jan. 1, 2023, Physicians Health Plan (PHP) implemented the following clinical edit:

• Bundling MMR vaccine code 90707 and varicella vaccine code 90716 into the combined MMRV vaccine code 90710 when billed together.

PHP is correcting this clinical edit with an effective date of Jan. 1, 2023.

Once the correction is made, all affected claims will be reprocessed.

Effective March 1, 2023, the time frame required to file an appeal will change from 90 to 180 calendar days from the date of an initial claim denial or adverse benefit decision to file a provider appeal.

You now have the option to email your completed provider appeal form directly to PHPProviderAppeals@phpmm.org. Access to the provider appeal form can be found in the forms section.

‍PHP values your feedback as an essential part of our continuous process improvement, and we thank you for your continued compliance with our provider appeal process.

Important information regarding the PHP Standard Fee Schedule effective April 1, 2023.

The 2023 Primary Care Management Incentive Program (Previously known as the Primary Care Incentive Program, or PIP) communication and technical guide are now available. Access the MyPHP Provider Portal, and select Provider Incentive Program in the Quick Access section to learn more.

Physicians Health Plan (PHP) is committed to improving the health of individuals, families, and communities. As part of this commitment, PHP participates annually in Health Effectiveness Data and Information Set (HEDIS).

The HEDIS MY 2022 audit process will be conducted from Feb. 2023 through May 2023. 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 in a manner consistent with CDC COVID19 guidelines.

Please view the provider letter for more information.

Physicians Health Plan (PHP) has identified there was a printing error with the 1099-MISC form. PHP will be reissuing corrected 1099 forms as quickly as possible. We apologize for the error and inconvenience this may cause.

PHP recently announced that the PHP Medicare Provider Portal is temporarily unavailable. The PHP Medicare portal is now fully functioning. If you enounter an issue using the single sign on from the MyPHP Provider Portal into the PHP Medicare portal, please email the PHP Provider Relations team, PHPProviderRelations@phpmm.org.

PHP is temporarily suspending prior authorization requirements for admissions to in-network skilled nursing facilities (SNFs) through Jan. 31, 2023. This applies to both PHP Commercial and PHP Medicare. Learn More

PHP is hosting a free Diabetes PATH workshop via Zoom on Tuesdays, Jan. 10 through Feb. 14, 2023, from 6-8:15 pm. The workshop offers information on healthy eating, how to make meal plans, fitness and exercise, preventing complications, monitoring blood sugar, relaxation techniques, and much more.

This is a wonderful opportunity to learn valuable information about living with and managing diabetes from the comfort of your own home. Please see the attached flyer for more information.

PHP is sponsoring a FREE Hypertension Prevention and Management: Nutrition Education Webinar for all PHP and SPN members. Please choose one of the following dates:

• Thursday, Nov. 17, 2022, from Noon to 1:00 p.m.
• Thursday, Dec. 15, 2022, from Noon to 1:00 p.m.

The webinar is led by a Sparrow Registered Dietician. Please see the attached flyer for more information about this educational seminar and how to register.

Effective October 1, 2022, Prior Authorization for PT & OT is no longer required for SPN Plans. See the SPN PA for PT and OT Flyer for more information.

Effective Dec. 1, 2022, to Dec. 31, 2022, PHP and PHP Medicare will temporarily suspend prior authorization requirements for admissions to in-network skilled nursing facilities (SNFs). Learn More

Chronic Pain-PATH Workshop - a free zoom program for all PHP members. Learn More

For more information please review the notice, or select Electronic Funds Transfer (EFT) in the left side pane of this page.

Physicians Health Plan (PHP) is excited to introduce a new electronic payment (ePayment) platform called, ePayment Center, to accelerate and add efficiency to our claims payment process. PHP has partnered with Zelis^® Payments to offer you secure ePayment options effective June 14, 2022.

The current electronic platform through PNC Bank Remittance Advantage will sunset as of May 31, 2022, and will not be able to accept any new enrollments after May 22, 2022.

‍Read full notice for important information and next steps.

Physicians Health Plan (PHP) has become aware that provider Explanation of Payments (EOPs) are reflecting dollar amounts incorrectly for adjusted claims only. It has been identified that extra 0 “zeros” were added to adjusted claims. This issue did not impact the actual payment issued. It only impacts the information on the EOP. PHP is working diligently to correct this issue. Additional updates will be posted as available.

Effective June 6, 2022, auto authorization will allow you to:

• Submit authorization requests electronically
• Get immediate response for the authorization status
• Determine if a medical service requires prior authorization

See the flyer for more information on 2022 training sessions and how to register for a session.

Diabetes-PATH Workshop - a free zoom program for all PHP members. Learn More

Prior authorizations will now be required as outlined in the Notification and Prior Authorization Table for:

• Skilled Nursing Facilities (SNF)
• Long-Term Care Hospitals (LTACH)
• Inpatient Acute Rehabilitation (IPR)

Please note, notification is required for all services detailed in the authorization/notification table.

Click here to learn more.

PHP is proud to announce that the 2022 Primary Care Incentive Program and Communication is now available. Log into your MyPHP account then click on "Provider Incentive Program" in the green tool bar to learn more.

This update is to provide clarity on how routine eye exam claims should process. See the flyer for more information.

Physicians Health Plan (PHP) is transitioning to a new mailing address. All Providers can begin using the new mailing address right away! All mail sent to the Old Mailing Address will be forwarded on your behalf to the New Mailing Address thru Sept. 30, 2022. Please update your records and transition to the New Mailing Address before Sept. 30, 2022.

New Mailing Address Old Mailing Address

Physicians Health Plan Physicians Health Plan
PO Box 313 PO Box 853936
Glen Burnie MD 21060-0313 Richardson TX 75085-3936

Payment for the 2021 Primary Care Incentive Program has been issued, if an incentive bonus was achieved. The final report and provider notice can be accessed through the MyPHP Provider Portal.

Change Healthcare has a new mailing address, effective May 1, 2021. Please update your records.

‍Change Healthcare
‍Attn: Pre-Pay
1849 West Drake Drive
Ste 101
Tempe, AZ 85283

Learn more about U-M Health + St. Joe's Advantage Plan, effective January 1, 2022. Click here to learn more and register

Diabetes PATH - free Program for all PHP Members Learn More

Chronic Pain PATH - free Program for all PHP Members Learn More

The 2021 PHP Primary Care Incentive Program Reports are now available in the MyPHP Provider Portal and the next updated report will be available May 15th. Qualified PCPs can access their rosters by logging in at PHPMichigan.com/MyPHP. Updated reports will be available in the portal on the 15th of every month. To maximize your incentive payout, please review monthly.

If you have questions or need to register for the portal, please contact Provider Relations at PHPProviderRelations@phpmm.org.

Diabetes PATH - free Program for all PHP Members Learn More‍

‍Diabetes Prevention Program - PHP is pleased to partner with National Kidney Foundation of Michigan to offer our members resources to understand and address prediabetes. The Diabetes Prevention Program is free to PHP members and includes an online assessment and online workshop where members will be guided to a healthier, happier life. See attached flyer for information on how members can test their diabetes risk and enroll in this fully virtual group program.

Effective January 1, 2021, procedure codes, 99050 and 99051 will no longer be separately reimbursed by PHP. Learn More

Effective immediately, PHP no longer requires notification of acute maternity admissions or newborn admissions, unless the admission exceeds the federal mandate LOS of 48 hours after vaginal delivery or 96 hours after cesarean section delivery. If the acute maternity admission or the newborn admission exceeds the federal mandate, please contact the PHP Medical Resource Management team at 517.364.8560 to provide notification.

PHP is proud to announce that the 2021 Primary Care Incentive Program and communication is now available. Log into your MyPHP account then click on Provider Incentive Program in the green toolbar to learn more.

Learn more about PHP's new Michigan Care plan effective January 1, 2021. PHP invites you to attend a virtual training session outlining the requirements of the Michigan Care plan. Click here to register for one of the trainings

Medicare Advantage plans are one of the fastest growing Medicare products on the market. PHP is proud to launch our new plans Jan. 2020. Click here to register for one of the trainings.

PHP is offering a free Hypertension Prevention and Management Nutrition Education Webinar to all PHP Members   Learn More

PHP is hosting a free Chronic Pain PATH Workshop for all PHP members. The workshop will offer information on the mind-body connection, distraction techniques, healthy eating, goal setting, and much more! This is an opportunity for members to learn more information about living with and managing chronic pain from the comfort of their home  Learn More

Diabetes PATH - Free Program for all PHP Members Learn More

2020 Primary Care Incentive Program Reward is Changing. Log into your MyPHP account then click on Provider Incentive Program in the green tool bar to learn more.

PHP will add new announcements to the Provider Home Page.  These past notice links are for your reference:

‍Triple Aim Incentive Program Report Is Now Available‍

‍Important Notice Regarding The Triple Aim Incentive Program Reports‍

‍PHP Incentive: PHP's Adult ACA Wellness Visit Program‍

‍Timely filing limit changes‍

‍Electronic Funds Transfer (EFT)

‍‍PHP's Adult ACA Wellness Visit Program Communication‍

‍PHP's Adult ACA Wellness Visit Program Description‍

‍PHP's Adult ACA Wellness Visit Program FAQ‍

‍PHP's Adult ACA Clarification Letter

‍‍PHP's Adult ACA Wellness Visit Program Outbound Calls‍

‍Behavior Health Standard Fee Schedule April 1, 2019‍

‍PHP Standard Fee Schedule April 1, 2019

Important changes are coming to PHP's requirements for submitting claims. Click Here

PHP is excited to announce that you are now able to receive your PHP payments electronically! Learn more.

Take Control of your Blood Pressure - Free Program to all PHP and SPN Members Learn More

Effective April 1, 2020. Learn More

Diabetes PATH - Free Program for all PHP Members Learn More

Diabetes PATH - free Program for all PHP Members Learn More

Chronic Pain PATH - free Program for all PHP Members Learn More

Registration is REQUIRED to receive an Electronic Remittance Advice (ERA) for PHP Medicare. You must register with Change Healthcare Electronic Data Interchange (EDI). Failure to register will result in your remittance advice being issued in paper.

‍ERA Enrollment Form Institutional

‍ERA Enrollment Form Professional

PHP is continuously reviewing ways to improve our claims processing accuracy and consistency. PHP is implementing an automated clinical editing solution, ClaimsXten Select. This will apply to all claims processed by PHP on or after June 10, 2019.
‍Learn More
FAQ

Physicians Health Plan has recently become aware that codes 97793, 99151, 99203, 99495, and 99496 are denying inappropriately with remark code N04 , “This service is considered a part of the original surgical procedure.” The issue has been corrected and adjustment projects have been submitted, please allow up to four weeks for claims to reprocess. If you feel that additional claims have denied inappropriately with remark code N04, please reach out to the Provider Relations team at PHPProviderRelations@phpmm.org. We are sorry for any inconvenience that this has caused, and we are working diligently to capture all affected claims and to ensure this does not happen again in the future.

2020 Provider Incentive Reports are available for PCPs who qualify for PHP's 2020 Primary Care Incentive Program. The reports are available for each qualifying physician which includes the list of members qualifying for each measure. Reports will be available the beginning of every month. Learn More

Effective Oct. 1, 2018 prior approval is required for all dates of service, replacing past practice of requiring prior approval at the fourth date of service. Learn More

New opioid utilization management strategy starting July 1, 2018, in conjunction with Michigan Senate Bill 274. SB 274 requires that prescribers “cannot prescribe more than a 7-day supply of an opioid within a 7-day period if treating a patient for acute pain.”

For more information on Senate Bill 274 and other Michigan opioid prescribing provisions go to the:

Michigan State Medical Society

Opioid Member Flyer