Physicians Health Plan (PHP) > For Providers > Medical Resource Management

The Medical Resource Management Department provides access to staff for members who seek information about the utilization management process and the authorization of care. Staff is available during normal business hours at the following times:

Monday through Friday from
8:00 a.m. – 5:00 p.m. Eastern Time

The toll free line is: 866.203.0618

The local line is: 517.364.8560

To contact the Case Manager for urgent and emergent calls after normal business hours, please call:

Commercial Customer Service Lines:

The toll free line is: 800.832.9186

The local line is: 517.364.8500

FamilyCare (Medicaid) Customer Service Lines:

The toll free line is: 800.661.8299

The local line is: 517.364.8540

Our Customer Service Department is also available to help you Monday-Friday, 8:30am-5:30pm Eastern Time.

Medical Resource Management Model

Prior Authorization Refer to Notification Table

Hospital Stay Review
- Care delivered in most appropriate setting   - Reduce delays in access to tests and     procedures
- Plan appropriately for discharge

Post Hospital Discharge Assessment
Post Hospital Discharge for targeted diagnosis
- Provide assistance with in network medical specialties
- Educate about medical conditions and medications
    -Offer self-help tools and disease specific education
    -Assist with follow up for clinical care, physicians orders, post hospital appointments
    -Provide support with supplies, equipment, and community resources

Complex Case Management - Address gaps in care
- Provide access to specialists
- Educate about medications and disease process
- Offer self-help tools and information on disease process
- Assist with follow up for clinical care, specialty physicians, medications, and diagnostic testing
- Provide support with supplies, equipment and community resources

Transplant Services
- Care delivered in most appropriate setting by designated transplant network

- Assist with discharge planning

- Assist with follow up for clinical care, physician appointments, required post transplant related care

The Medical Resource Management Approach

Medical Resource Management is a highly structured and clinically intense set of processes that attempts to facilitate access to health care resources, decrease the “hassle” factor and improve members’ overall health care experience.

The following defines the functions performed in MRM.

Medical Resource Management Department improves relationships between doctors and patients by offering more resources than traditional health care programs, and makes it easy for patients to access the information they need about medical concerns.

Health education with a personalized approach.
We provide reminder programs for routine check-ups including flu shots, pap smears, immunizations, and mammograms. PHP also makes available our Healthy Mom Healthy Baby Program which helps expectant mothers obtain the information they need to experience a healthy pregnancy.

Hospital Review.
Everyone deserves an advocate when receiving inpatient care. We will facilitate access to specialists, help to make treatment plans timely, and prevent delays in patient procedures and tests whenever we can. Medical Resource Management Department also provides services for ensuring that the discharge process goes smoothly and all necessary equipment and supplies are available when you need them.

Healthy Focus Programs that empower our members.
We will help empower members who have conditions like asthma and diabetes by providing the information they need—everything from self-care education materials to health status tracking.

Post Hospital Discharge Program.
This provides a safe transition home after a hospital admission. After leaving the hospital, our Case Management nurses will call members to make sure that medication, self care information and supplies are easily accessible.

Complex Case Management offers all the resources patients with complex illnesses need.
Chronic conditions are difficult enough without worrying about coordinating long-term outpatient treatment programs. PHP makes outpatient care as easy as possible. Our Complex Case Management program focuses on stabilizing long-term outpatient care for members with complex conditions. If you or a family member that is enrolled with PHP would like to speak to a nurse about complex case management, please call 517.364.8560 or 866.203.0618.

	Medical Resource Management -- FAQ

Q1. What is Medical Resource Management all about? Q2. Will PHP allow payment for services that are requested by a physician? Q3. What's on the new prior authorization list?