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MeridianHealth (Meridian) Frequently Asked Questions

FREQUENTLY ASKED QUESTIONS 


GENERAL QUESTIONS


Who is WellCare?
-Founded in 1985 by a group of physicians in Tampa, Fla., WellCare is a successful and fast-growing managed care company focusing on families and children, seniors and those with disabilities and other complex medical needs.
-WellCare shares Meridian’s commitment to providing high-quality care and customer service. They serve approximately 4.4 million members who receive their health insurance coverage through Medicaid, Medicare Advantage and Medicare Part D as of June 30, 2018.
-As of June 30, 2018, WellCare operates Medicaid plans in 12 states, Medicare Advantage plans in 18 states and Prescription Drug Plans (PDP) in all 50 states and the District of Columbia.

Who is Meridian?
-Meridian serves more than one million Medicaid, Medicare Advantage, integrated dual-eligible and Health Insurance Marketplace members in Illinois, Michigan, Indiana and Ohio.
-Meridian Health Plan of Illinois, Inc. is the highest rated Medicaid plan in Illinois with an overall rating of 4.0 out of 5.0 according to NCQA’s Medicaid Health Insurance Plan Ratings for 2017-2018.
-Meridian also operates its own pharmacy benefit management (PBM) company called MeridianRx.

How does this benefit me?
-Our focus remains on serving our members’ needs and an important part of that is expanding their access to quality providers like you.
-We recognize our providers as partners in that mission. We will be looking for all opportunities to make your experience with us even better and to leverage the benefits this acquisition will bring to the table in provider engagement.  

 
MEDICAID PROVIDERS


What does this transaction mean for Harmony-exclusive Medicaid providers (not contracted with Meridian)?
-We plan to migrate Harmony members to the Meridian contract and platform effective January 1, 2019.
-We are confident that your provider network support system will be able to assist you in navigating any differences in administrative platforms.


What does this mean for providers contracted with Meridian?
-There will be no changes to your contract with Meridian.
-Your relationships with Meridian will stay the same.
-Meridian’s goal of partnering to provide high-quality care to our members remains unchanged.

How will claims be managed for services rendered prior to January 1, 2019?
-Claims for services rendered to eligible Harmony members prior to January 1, 2019 should be submitted to Harmony. There is no change.
-Eligible Harmony members who are admitted to an inpatient facility prior to January 1, 2019 and are discharged on or after January 1, 2019 remain the liability of Harmony and should be submitted to Harmony.
-Unless otherwise stated in your Provider Agreement, claims (initial, corrected and voided) must be submitted within 180 days from the date of outpatient service or discharge date or three (3) months from the primary insurance payment date (whichever is later).
-Current claim submission timeframes shall continue to apply.
-Current appeals and dispute processes and time-frames shall continue to apply.

Will the change have any impact on my patients’ plan benefits?
-
Your patients’ core/required plan benefits will remain unchanged.
-We are in the process of notifying Harmony members that they will become Meridian members on January 1, 2019 and what that means for them.
-As of January 1, 2019, Harmony members will have the advantage of Meridian’s optional benefits and will not have to pay any co-pays.
-Meridian optional benefits remain unchanged.

What will happen to open care plans and open authorizations for Harmony Medicaid members? 
-
All open care plans and open authorizations, including pharmacy, durable medical equipment (DME), transportation and waivers, will be transferred from Harmony to Meridian.

If I am a participating provider with WellCare / Harmony Health Plan of Illinois but do not participate with Meridian, will I now be participating with both companies?
-
No. At this time, there are no changes to your participation status, agreement, and provider relations staff with either company. 
-We will do outreach to any Medicaid network providers currently not contracted with Meridian before we move Harmony Medicaid membership to the Meridian contract.

Does this mean I need to enter into a new contract right now?
-
At this time, provider network processes and procedures will remain as is for providers contracted with both Harmony and Meridian. 
-If contract changes are needed in the future to ensure the continuity of the provider-member relationship, your network representative will be in touch with you to discuss.


I don’t know who my provider rep is.  Who can I call with questions?
-Providers can reach us online at wellcare.com or call WellCare/Harmony Health Plan toll-free at:
-Harmony 1-800-504-2766 (Medicaid)
-Meridian 1-866-606-3700 (TTY 711) (Medicaid)
-The Meridian and Harmony provider network teams will be working collaboratively as part of this integration.


MEDICARE PROVIDERS

Will the change have any impact on my patients’ plan benefits?
-No. For Medicare, the 2018 plan benefits for members enrolled in our plans remain as published and approved by CMS. Medicare Advantage benefits for 2019 will be reflected in materials for the 2019 Open Enrollment Period, October 15, 2018 – December 7, 2018 for a January 1, 2019 effective date.

If I am a participating provider with WellCare / Harmony Health Plan of Illinois but do not participate with Meridian, will I now be participating with both companies?
-
No. At this time, there are no changes to your participation status, agreement, and provider relations staff with either company. 
-We will keep you informed. The Medicare and Medicare-Medicaid Alignment Initiative (MMAI) contracts will continue to operate separately in 2018 and 2019.

Does this mean I need to enter into a new contract right now?
-
At this time, provider network processes and procedures will remain as is for providers contracted with both Harmony and Meridian. 
-If contract changes are needed in the future to ensure the continuity of the provider-member relationship, your new Meridian network representative will be in touch with you to discuss.


I don't know who my provider rep is.  Who can I call with questions?
-Providers can reach us online at wellcare.com or call WellCare/Harmony Health Plan toll-free at 1-855-538-0454.
-Meridian providers can call 866-606-3700 (TTY 711).
-The Meridian and Harmony provider network teams will be working collaboratively as part of this integration.


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Last Updated On: 11/27/2018