Medical Mutual - Health Plans for Life

Provider eServices

Medical Mutual offers electronic and internet based tools to simplify communications between providers and patients, that reduce cost and save time to enhance the efficiency of patient care.

Innovative solutions support clinical decisions at the point of care through integrated transaction processing. The Company works with mobile and web-based products to improve patient care with easy access to the most current clinical information.

Electronic Provider Vendor Services

  • ePrescribing

    Electronic prescribing (ePrescribing) can help put critical clinical information at the fingertips of physicians at the point of care. ePrescribing is a proven way of enhancing patient safety while reducing administrative cost and the workload in a physician’s office.

Outpatient Ambulatory Surgery Classification (ASC) Groups

Provider ePortal Brochure

  • This brochure provides a brief overview of the various provider services described below.

Provider ePortal Resources (Login required)

  • Fee Schedule Look-Up

    Search fee schedules online based on individual provider NPI and TIN combination to view contract rates by:

    • procedure codes most frequently submitted by your practice
    • specialty’s commonly submitted procedure codes
    • contracted fees for individual procedure codes

  • Coverage Maximum Defined Benefit

    Plan sponsors and employer groups insured by Medical Mutual may elect coverage maximums for specific lab services beginning January 1, 2016. This means some services will only be paid up to a coverage maximum for members of groups with this benefit.

    If a provider’s contracted rate is above the coverage maximum, members will be responsible for the amount in excess of the coverage maximum up to the provider’s contracted rate, in addition to their normal benefit plan out-of-pocket costs (e.g., deductibles, coinsurance payments). While members will have continued access to all network providers, they may choose a provider or facility whose contracted rates match or are below the coverage maximums to avoid additional out-of-pocket costs.

    More than ever, plan sponsors and employer groups are looking to implement cost-saving initiatives that provide members the quality care they need in the right setting at the right price. We are committed to working with providers to deliver both high-quality care and value to our members.

    Providers can take the following steps to prepare for the January 1 effective date.

    Review the 2016 Coverage Maximums
    A list of coverage maximums is available on the Fee Schedule tab inside the secure Provider ePortal to help providers determine if their contracted rates match or are below the coverage maximums. This may influence where participating members choose to receive services.

    Take an Active Role in Helping Members Make the Most of Their Benefits
    Providers should consider their roles in helping members maximize their benefits and minimize out-of-pocket costs. Knowing the costs of the providers you usually refer patients to in advance will result in a productive and beneficial engagement with members. Oftentimes, members follow their provider’s recommendation and direction.

    Be Prepared for Proactive Member Engagement
    Medical Mutual is encouraging members to actively participate in deciding where to receive lab services. Providers ordering lab work for Medical Mutual members may be asked where the test is being sent and the associated cost. If the suggested testing facility would require members to incur costs above the coverage maximum, they may ask for the test to be sent elsewhere.

    Members may also ask when scheduling an appointment if they need lab work and, if so, if they can get lab orders in advance. This would allow the member to get the sample drawn and analyzed at a lab provider of their choice.

    Members are being directed to use My Care Compare, an online tool that provides cost estimates and quality ratings for in-network facilities and providers. The cost estimates provided will allow members to determine if providers’ contracted rates match or are below the coverage maximums.

    Learn More

  • Claims & Eligibility

    • Eligibility & Benefits
      Verify a member's eligibility and benefit information, including copays, coinsurance and deductibles.

    • Claims
      View the status of paper claims or electronic claims submitted through the Provider ePortal including member information, date of service, charges and payment date.

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