MHP is a leading preferred provider organization (PPO) network in Georgia and South Carolina. We were founded in 1996 by the Memorial Health system in Savannah, Georgia. We offer coverage in 26 Georgia counties and three South Carolina counties.
To verify insurance benefits, patient eligibility, or payment status on a claim, please contact the claims administrator. The phone number is listed on the member's insurance I.D. card under "benefit eligibility" or "benefit verification."
MHP is not an insurer. We do not have private information about members or their dependents.
MHP contracts with insurance companies and third-party administrators. Groups can access the MHP network through any one of these carriers or claim administrators. Contact MHP at (912) 350-6608 for a current listing.
Search our online directory of in-network providers, or call our customer service center at (877) 342-0280. Our directory is updated monthly.
Yes, MHP is fully compliant with all of the requirements of the federal Health Insurance Portability and Accountability Act (HIPAA).
Please email to be added to the mailing list. The MHP newsletter is published quarterly and distributed via email.
Please email to be added to the mailing list. The MHP newsletter is distributed via email. Please include your name, email address to send the newsletter and the provider you represent.
Claims should be sent to the address listed on the member's I.D. card. You may contact the third party administrator or insurer for the EDI filing number and requirements.
Payment is issued by a third party administrator or insurance company listed on the member's I.D. card. MHP is a preferred provider organization (PPO) network and does not issue payments.
No. Participating providers may bill a member directly for non-covered services as long as the member has been informed in writing, prior to the service, that it is not covered. The member must then elect, in writing, to receive the service and accept responsibility for payment.
Not necessarily. If a practice is listed as a participating provider, not every physician in that practice may be considered a participating MHP preferred provider. When scheduling an appointment at a physician's office, hospital, or facility, it is important to verify that the provider you wish to see is part of the MHP preferred network. You can also verify provider's participation by calling (877) 342-0280.
Some certification requirements are stated on your insurance card along with the number to call for pre-certification. A more detailed list is available from your third party administrator.
Certification is not a guarantee of payment. The certification process confirms the medical necessity of the service. It does not confirm the member's eligibility or coverage for the service. All questions of eligibility should be confirmed by contacting the claim administrator.
Medical necessity and other determinations are made by the employer's/group's contracted medical management company.
An appeals process is available. Please contact the pre-certification number listed on the insurance card to initiate the process or follow the instructions on your certification notice. You are encouraged to send complete information and medical records regarding the non-certified period. All information received will be reviewed and a final decision will be made. A written notification of the decision will be sent to the patient, providers, and claim administrator.
Case management is a program that allows for early intervention and management of cases involving serious or catastrophic injuries or illnesses. Case managers are registered nurses who work with the patient, the providers, and the claim administrator to ensure that the patient is receiving the right level of care at the right time. Case managers help to make the most efficient use of health plan benefits over the course of long-term treatment.
Our re-credentialing process consists of re-verifying and updating providers' credentials. This is done every three years.
No, MHP cannot make an effective date retroactive. The effective date given is the first day of the month following the date credentialing is completed and approved by the MHP credentialing committee.
Our re-credentialing process consists of re-verifying and updating providers' credentials. MHP re-credentials providers every three years. The re-credentialing anniversary is the date that the initial credentialing was completed, reviewed, and approved by the chairman of the MHP credentialing committee.
No, MHP is unable to accept the CAQH application. However, you may download the GAUH information onto the Georgia Uniform Application using the download button on the CAQH website.
The MHP network covers 26 Georgia counties and three South Carolina counties.