Medical Mutual of Ohio TPA Update

Provider Brief     January 2020

Effective January 1, 2020 Medical Mutual of Ohio became the third-party administrator (TPA) for the Premier Health Employee plan. Premier Health Employees are being offered two health plans. These include the Premier Health Traditional Plan and the Premier Health Saver Plan. The Premier Health Group (PHG) network is continuing to serve as the Tier 1 provider network for the Premier Health Employee Plan.

To receive payment for claims for dates of service in 2019, you must submit all claims by May 1, 2020 as stated in the contract. Submit claims to Premier Health Plan, not Medical Mutual. Timely filing requirements and current reimbursement rates apply.

For employees covered by the Premier Health Traditional or Saver Plans, claims with dates of service on or after January 1, 2020 should be submitted directly to Medical Mutual. The Medical Mutual payer ID is 29076. PHG current reimbursement apply for both plans as well.

You will work directly with Medical Mutual on all inquiries related to eligibility, benefits, claims and care management requests, as you do today for your Medical Mutual patients.

Please feel free to contact PHG directly at (937) 499-7441(937) 499-7441 with any questions. Thank you for your continued commitment to excellence!

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