FAQs

You can find information on prior authorizations on our Prior Authorization page.

Find the Meridian Provider Manual, fillable medical and pharmacy forms, behavioral health tools, care coordination resources, and more on our Provider Manual Page.

Visit our Billing & Payments page for more information. Providers may also submit and check the status of claims electronically via the secure Meridian Provider Portal.

The Provider Portal is a secure, online tool that allows PCPs, specialists and hospitals to view and create online authorizations and referrals, view specific preventive health care services needed for patients, and verify eligibility and status claims online. It is a real-time information system available to all contracted providers free of charge.

Please contact your Provider Engagement Administrator via our Provider Relations page or use our Provider Relations Intake Form for assistance.

Serving close to 1 million members across Illinois, our network includes more than 220 hospitals, 21,000 primary care providers, 43,000 specialty providers, and over 5,700 behavioral health and substance use providers.

To become a contracted Meridian provider, complete the Network Intake Form.

To ensure and maintain a high standard of medical care, all Medicaid providers must be credentialed through the HFS IMPACT registration system. Meridian is unable to contract with a provider until they are approved through IMPACT.

Learn more on our Join Our Network page.

Primary Care Providers

Recommended New Verbiage: Meridian contracts with Primary Care Providers on a fee-for-service basis, with quality bonus incentives. Our focus on quality, allows physicians to do what they do best: treat patients.

Specialist Providers

Meridian values the relationship with our specialist providers and seeks to limit the amount of "red tape" whenever possible, especially with referrals and authorizations. Meridian continues to provide prompt claims payment to specialist providers.

Hospital Providers

Communication is the key to all mutually beneficial relationships. In this regard, Meridian makes every effort to partner with each contracted Hospital in coordinating the care of its beneficiaries. Hospital providers can count on Meridian to help serve their communities with as little interference as possible.

No. Providers can choose whether they will accept new patients.

Yes, contracted PCPs with Meridian are given complete control over their panels. They can determine the number of patients they will accept, as well as any gender or age restrictions.

For questions regarding your affiliation or contract-related issues, contact our Contracting Department at ILJoinOurNetwork@centene.com.

For general questions, visit the secure Meridian Provider Portal or call Meridian Provider Services at:

• Meridian Medicaid Plan: 866-606-3700
• Meridian MLTSS: 866-821-2308

Members will continue to receive their HFS MEDI card once enrolled with Meridian. They will also receive a Meridian ID card for each member of their family that is enrolled. This card will have our logo, phone number, PCP name and recipient ID number. Providers can use the online MEDI system to check Medicaid eligibility. Or, log into the secure Meridian Provider Portal to confirm benefits.

No. In-Network PCPs do not need a referral to see a Meridian member, even if the member is not assigned to them.

No. In-network specialists do not need a referral to provide services in their offices.

While a referal wouldn't be needed, a provider may need a prior authorization depending on the service. Please use our Medicaid Prior Authorization tool for services that require prior authorization.

Yes. PAs, NPs, and APNs are able to contract directly with Meridian.

Yes. Meridian pays all the provider add-ons that the state pays.

Yes. Meridian follows the State of Illinois billing guidelines unless otherwise noted.

Unlimited outpatient visits are available.

To verify if prior authorization is required, providers should refer to the Medicaid Prior Authorization tool.

Meridian requires notification if you anticipate the member will require more than 3 visits for treatment. The notification must include the DSM-IV diagnosis, reason for continued treatment and status of PCP notification. Please fax the completed Continued Outpatient Treatment Notification Form (PDF) to 313-202-1268.

No. Up to 5 hours of testing is permitted using either CPT code 96101 or 96102. The tests and measures must be rendered by full, limited-licensed, or temporary-limited-licensed psychologists.

No. Meridian reimburses for one "psychiatric diagnostic interview examination" (CPT Code 90801) per year per provider group.

Call the Meridian Behavioral Health Department at 888-222-8041 to notify us of your evaluation. Our staff will coordinate the referral services with the member's CMH center.

After the initial assessment and for ongoing coordination after the 3rd visit by sharing the COTNF.