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Provider Center

JOIN OUR NETWORK

Providers are essential for connecting Polk HealthCare Plan members to the health services they need. We are committed to providing you with resources and information that will support our partnership and your efforts to serve our plan members.

Interested in becoming a Polk HealthCare Plan provider?

Join our Network
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Forms & Documents

Documents and forms are intended ONLY for current contracted PHP Network Providers.

Our goal is to provide you with what you need so you can focus on providing the best care possible to our members.

PHP-Precertification-Form-2024-LM-ada

Pre-certification Form

Download
PHP-Specialty-Referral-Form-2024-LM-6-11-ada

Specialty Referral form

Download
2024-Polk-HealthCare-Plan-Formulary-Drug-List-ADA

Formulary

Download
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Provider Support

Eligibility

If you need information regarding a Polk HealthCare Plan member’s eligibility, please contact customer service at (863) 533-1111.

Claims/Benefits

Meritain is the third-party administrator for claims and medical management. Should you need access to claims or benefit information, please visit their portal.
Meritain Portal

Claim Submission

Claims may either be mailed to

Meritain Health
P.O. Box 853921
Richardson, TX
75085-3921

or submitted electronically to EDI: WebMD/Emdeon 41124 or McKesson/Relay Health 1761.

Claims Appeals

Please mail all claims appeals to:

Meritain Health Appeals Department
P.O. Box 41980
Plymouth, MN 55441-0970

Provider Services

Should you have a need that is not eligibility, claim or benefit related, please contact the Polk County Indigent Health Care Provider Services office at (863) 519-2003.

Go to Portal

Quick Reference Chart

ServicesVisit Limits Per plan Year (October 1- September 30)Approvals
Primary CareUnlimitedNo Pre-Cert Required
Specialist20 Visit Limit (does not refer to procedures)No Pre-Cert Required
CT Scans4 Visit LimitNo Pre-Cert Required
MRI/MRA*3 Visit Limit Combined MaxNo Pre-Cert Required
PET Scan2 Visit LimitNo Pre-Cert Required
Ultrasound6 Visit LimitNo Pre-Cert Required
Physical Therapy, occupational Therapy and Speech Therapy36 Visit Limit Combined MaxNo Pre-Cert Required

*Visit Limit Combined Maximum refers to a grouping of services or therapies, in which the number of total visits for each service or therapy should NOT exceed the number of combined visit limits.

Lab Services

All blood work must go through Laboratory Corporation of America only. All pathology must go to Laboratory Corporation of America or Micro Path Labs only.

X-Rays

Simple bone and joint X-rays may be done in your office if available. If not available at your office, the member must go to one of our contracted radiology groups.

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