Frequently Asked Questions
Answers to commonly asked questions about the credentialing and claims processes are provided below.
PHP does not credential physician assistants or CRNAs. PHP does credential nurse practitioners who have a master’s degree in nursing and are board certified. Nurse practitioners also require a collaboration agreement with a physician in their practice.
This information is required by the State of Michigan and must be on file to complete each credentialing and recredentialing application. A PHP credentialing coordinator will go to a state website to perform a search by name and/or social security number to determine if an individual has any criminal history with Medicaid or Medicare. The addendum will require the signature of the individual practitioner undergoing the credentialing or recredentialing process.
Hospital-admitting privileges are required for most specialties. If you do not have admitting privileges at a participating PHP hospital, you must make arrangements with another participating practitioner within your specialty to handle admissions. This arrangement needs to be in writing and signed by the individual willing to provide this service. Contact a PHP credentialing coordinator to determine if your specialty requires hospital privileges (and, if so, whether you are able to use a designee) and to obtain a current list of participating hospitals.
A copy of your DEA certificate and professional liability, a completed application and – for solo practices – a signed contract.
The practitioner needs to be residency trained or board certified in the specialty in which he or she is applying.
Limits depend on the specialty. Please contact a credentialing coordinator for further information at 517.364.8312.
Applicants have the right to be informed of the status of their application. Request for status may be in writing or by calling PHP at 517.364.8312. PHP will respond to your request within two business days. Please contact PHP for further information regarding what types of information may be disclosed to you regarding your application.
Providers can check eligibility and claim status by signing up for the MyPHP Provider Portal.
Submit your claims to the following address:
Global-Care
PO Box 247
Alpharetta, GA 30009-0247
Or submit your claim electronically by using the following information:
Payor ID: 07689
Payor Name: PHP
Please review the PHP Provider Directory or contact PHP Customer Service at 800.832.9186 for commercial members or 800.661.8299 for Sparrow PHP members.
Your office will need to submit a Provider Information Update Form.
PHP does release fees, but we ask that you please contact your provider relations coordinator directly at PHPProviderRelations@phpmm.org .
PHP does provide training and new provider orientation either in your office or at PHP. Please access the Training Opportunities page for more information.
Review the latest Provider Manual.
