Practitioner Rights & Responsibilities
MidMichigan Health Network (MHN) recognizes the vital role that practitioners of all specialties and services play in the success of managed care. Effective communication between practitioners and MHN is essential.
In order to ensure consistency of the information provided to enrollees, please contact Customer Service to report changes in any of the following:
- Office or Billing Address
- Telephone Number
- Office Hours
- Procedures for Call Coverage or On-call Arrangements
- Tax I.D. Number or Corporate Name
- Medicare Provider Number
- DEA Number
- Status of Hospital Privileges
- License to Practice
- Limits Placed on Practice
- Professional Liability Insurance Coverage
- Specialty Change or Change in Board Certification Status
- Physician joining or leaving practice
- Decision to terminate participation in any/all contracts (requires written notice)
- Any information that may affect current contracted relationship
As a network practitioner, you have the responsibility to direct patients to other network practitioners for specialty care and to network hospitals and laboratories for testing and treatments whenever possible.
Practitioners have the right to review information submitted in the credentialing process and the right to correct erroneous information. Further, practitioners have the right to request a status of their credentialing or recredentialing application. A practitioner is entitled to a formal hearing and appeals process. For additional information regarding rights related to credentialing, please see MHN Credentials Policies and Procedures.
A practitioner may review UM criteria utilized in decision-making with a UM staff member at the ConnectCare offices from 8:00 a.m. - 12:00 p.m. and 1:00 p.m. - 5:00 p.m. Monday - Friday (Eastern Time). Proprietary criteria are exclusively governed by the terms and conditions of a time-limited License Agreement and may be shared only under the terms of these agreements. To address questions and issues related to utilization please contact 989-839-1629 or toll free at 888-646-2429 or fax 989-839-1679.
UM decision making is based only on appropriateness of care and service and existence of coverage. The organization does not specifically reward practitioners or other individuals for issuing denials of coverage. Financial incentives for UM decision makers do not encourage decisions that result in underutilization.
Rev. 1/11/06, 2/06, 7/08, 10/08. 12/09, 5/10