Keep Us "In The Know"

As participating physicians and providers in our network, PHPMM requires updates regarding the status of your professional practice and other information relative to the services you provide. The obvious changes that are outlined in your contract and the provider manual are things like:

• Changes in privileges (hospital or ambulatory care center)
  
• Licensure
  
• Prescribing ability or ability to perform professional duties
  
• Sanctions or debarment status

Other changes that we require notification of are demographic or status changes like:

• Telephone number
  
• Tax ID number
  
• Billing address
  
• Office practice address
  
• Acceptance of new patients
  
• After hours availability
  
• Physicians joining or leaving your practice
  
• Leave of absence

This allows us to more accurately maintain data that we reference when it comes time to send out a recredentialing application, notification of a change in reimbursement, issue payment, or award credit for a Physician Incentive Plan measure. This information is essential for us to have in order to provide you with efficient service and timely communication. Additionally, it helps to assure correct payment for claims submitted. The information submitted to PHPMM on a claims form must match the information presented to us on a W-9. Inconsistencies in this may result in incorrect claims payment.

To assist you in making a change, please click_here  to access a change form.  It can be faxed to the Network Services Department  at 517.364.8412.  Thank you in advance for your cooperation and communication.

 

 

Notification of Termination

The National Committee for Quality Assurance (NCQA) developed a new standard, effective July 1, 2003. This requires contracts with PHPMM specialists or specialty groups to reflect language, stating that practitioners will provide timely notification to their patients of a termination of their contract with PHPMM. This will affect all physicians and practitioners whether they are individually contracted or contracted as a part of a group. PHPMM has undertaken this responsibility for all physicians and practitioners who make up the Physicians Health Network including primary care, and specialists. Our contracts are currently being revised to state "Prior to termination of this Agreement, HDN (PHPMM) shall notify all affected members and assist them in obtaining a referral to a participating provider (or primary care physician as applicable)." For this reason, it is imperative that notification be provided to PHPMM at least 30 days in advance of a change in your participation status. In order to provide continuity of care and to comply with NCQA and contract language, this information must be submitted in writing to PHPMM to the attention of the Network Services Department. Thank you in advance for your compliance with this requirement.