McLaren Health Plan is a Health Maintenance Organization (HMO) dedicated to meeting the health care needs of each Member. To this end, our mission is to develop a health care network that offers high quality, accessible and cost-effective health services throughout our service area.

As an HMO, McLaren Health Plan combines the resources of independent physicians, multi-specialty groups, ambulatory care centers, ancillary providers and hospitals to offer members access to a comprehensive array of high quality health care providers.

McLaren Health Plan recognizes members may have medical or social needs which cannot be fully addressed by a single physician or other health care provider. To prevent these members from "falling through the cracks" of a delivery system, McLaren Health Plan’s Medical Management Department offers physicians support through the resources of Nurse Case Managers to ensure members have access to the health services they need. The nurses are available 24 hours per day 7 days a week and work under the direction of the Chief Medical Officer.

Through case management services, the nurses promote health management to our members by focusing on early assessment for chronic disease and special needs and by providing education regarding preventive services.

McLaren Health Plan remains committed to offering providers competitive reimbursement for the high quality services provided. We are pleased to announce the annual changes to the Commercial fee schedule have been completed and are effective for dates of service on or after September 1, 2008.

Key highlights include:

• Increases to the Evaluation and Management office visit codes
• Significant increases for immunization codes, including the administration fee

In general, professional services increased by 2.8%, however providers may see variations in fees among specialties and codes.

MHP has selected JVHL as our new exclusive vendor for laboratory services beginning March 1, 2009. JVHL will provide you and your patients with responsive, convenient, high quality services. JVHL specializes in outreach laboratory services with more than 400 phlebotomy locations, full-time courier services, and 24 hour/7 day client services support. For a listing of service centers and a provider directory, please visit the JVHL website at www.jvhl.org.

In an effort to provide our pregnant members with the most appropriate, high quality care available, MHP has requested all MIHP providers sign a Medicaid Care Coordination Agreement. MIHP provides preventive services to pregnant women, mothers, and their infants to help reduce maternal and infant mortality and morbidity. MIHP is intended to supplement regular prenatal/infant care. MIHP services include:

• Psychosocial and nutritional screening
• Plan of care development
• Referral to community services
• Referral to childbirth or parenting classes
• Coordination with medical provider and MHP

If you have any questions regarding MIHP or would like to refer a patient to MIHP, please contact Medical Management at (888) 327-0671.

Specialty Network Access Facilities

Over the past several months, the Department of Community Health, the Medicaid Qualified Health Plans, and the four Public Entities (University of Michigan Health System, Wayne State University, Hurley Hospital, and Michigan State University) have worked on a joint initiative to increase access to specialty care services to Michigan Medicaid recipients. Medicaid recipients are able to access the specialty care providers affiliated with these public entities that are unavailable through MHP’s contracted network. If you determine that a member is in need of a specialty care service that is not sufficiently available within MHP’s network, please fax a MHP referral form to Medical Management at (877) 502-1567. It is our hope that this process will increase the care and access to necessary specialty care to Michigan Medicaid recipients. If you have any questions, please call Medical Management at (888) 327-0671.