| NEED HELP QUICK? For questions about eligibility, coverage or claims, call -- 888-492-6811 |
Frequently Asked Questions
for Physicians
How do I verify eligibility and benefits for a SmartHealth enrollee?
Contact Automated Benefit Services at 888-492-6811 between 8:30 am and 4:30 pm Monday through Friday to verify eligibility and benefits, or use the 24/7 automated system at 888-494-4600.
Is on-line eligibility verification, benefits and claims look up available?
This functionality is not currently available for SmartHealth, but we hope to offer it soon.
Where do I send my claims for SmartHealth?
- Mail paper claims to:
ABS for SmartHealth
P O Box 37705
Oak Park, MI 48237-7705 - Electronic filing: Payer ID 38259
Are there office visit co-pays?
SmartHealth participating physicians should apply the following co-pay structure:
Type of Service |
PCP |
Specialist |
Preventive Services
|
|
|
Office visits |
$15 |
$20 |
Prenatal |
|
$20 for first visit only |
Outpatient Mental Health |
|
$15 |
Chiropractor |
|
20% |
Urgent Care |
|
$20 |
Does a SmartHealth patient have other out-of-pocket expenses that my office should know about?
When enrollees receive care within the designated SmartHealth network of providers available through Ascension Health Michigan ministries, there is little or no out of pocket expense and few prior authorization requirements. However, you should be aware of the following:
- ER co-pay of $100 applies in the SmartHealth network, so make patients aware of your available office hours or preferred urgent care site(s)
- Laboratory services – SmartHealth patients expect to incur no out of pocket expenses beyond an office visit co-pay (when applicable) when accessing care with a SmartHealth provider. Therefore, it is extremely important to route laboratory specimens to a SmartHealth affiliated laboratory to avoid unnecessary expense to the patient.
REMEMBER: Patient out-of-pocket expenses are greater when care is provided by non-Ascension Health / non-SmartHealth physicians or hospitals. Therefore, when you need to personally provide a service outside of your office, or refer a patient, utilize the SmartHealth delivery network whenever possible, to help reduce the cost of services provided by non-participating providers and to ensure patient satisfaction.
Are there significant prior authorization requirements?
SmartHealth has limited procedures and services that require authorization. For a list of specific services requiring prior authorization, review the SmartHealth Provider Manual available online at www.smarthealth-mi.org.
Obtain Prior Authorizations for the Medical Management Program according to the following directions:
- Fax Prior Authorization form (available online) to the SmartHealth Medical Management Department at 586-753-0981
- Contact the SmartHealth Medical Management Department at 800-869-8388