No, practitioners may submit their claims electronically. However all paper claims for outpatient services must be submitted using the CMS (HCFA)-1500 (PDF).
No. Practitioners may log in and submit these kinds of changes using the "Profile" section of this website. Practitioners can also call our Professional Relations department at (800) 541-3353 to make changes to their practice information.
MHN contracts with the owner of the TIN. An individual contract represents the owner of the TIN, operating under their own name in a solo practice. Practitioners who are operating under a fictitious business name or share a TIN with other practitioners or entities must obtain a group contract with MHN.
Common reasons for termination of a practitioner's network participation are.
- Failure to adhere to contractual requirements.
- Inability or unwillingness to comply with MHN administrative requirements for network participation, including failure to comply with utilization management or credentialing procedures.
MHN does not terminate practitioner participation on grounds that the practitioner.
- Advocated on behalf of a member.
- Filed a complaint against MHN.
- Appealed a decision of MHN.
- Requested a review or challenged a termination decision.
Authorization information is sent to the address where the service (appointment) is to take place, unless the practitioner has notified Professional Relations that a particular address is not a mailing address. If the service address is not a mailing address, the authorization paperwork will be sent to the practitioner's primary address, as indicated on their practitioner application.
All other communications are sent to the practitioner's primary address, indicated on the application. To change your address, log in and use the "Profile" section of the website to submit changes. You may also contact Professional Relations at (800) 541-3353, 10:00 AM to 2:00 PM Pacific Time Zone.
To be listed in our directory, practitioners must be contracted with MHN and available for patient referrals. Also, practitioners must have responded to our annual Data Integrity Project (DIP) or credentialing materials.