Network Management

The MPHC Network Management team is responsible for growing and supporting our provider network. This includes contracting, credentialing new providers, data management, education and communications.

Network Management

Provider Inquiry

1-800-348-9804

1-888-732-7364

network.management@martinspoint.org

  • Provider Recruitment
  • Contracting
  • Education
  • Field Support
  • Incentive Reporting
  • Fee Schedules
  • Rate Negotiations
  • Claims Issues
  • Claims Questions
  • Dispute Process Questions
  • Underpayment/Overpayment Questions
  • Reimbursement Quotes

An important part of our job is making sure our health plan members have appropriate access to:

  • Regular and routine care appointments
  • Urgent care appointments
  • After-hours accessibility
  • Member services telephone representatives
  • Behavioral health care services

We measure our performance in this area regularly by looking at survey results, member complaints and grievances, and member services telephone records. If we identify any issues with access to specific practitioners, groups, or services, we work to immediately address the issues.

We also continually measure the geographic distribution of our members to determine how effectively our provider network meets their needs (as outlined by the Defense Health Agency, CMS and the Maine Bureau of Insurance regulations). Using GeoNetworks software, we routinely generate reports to identify opportunities for network enhancement. We look at parameters such as the number of members by market area and their average time to reach one to five providers in our network. If we identify any areas not meeting the access standard, we rectify the situation as soon as possible.

Customer Feedback

All customer feedback regarding provider office quality, safety or accessibility is reviewed by the Network Management Department to determine the need for a site visit. If a provider/office has been cited in two or more cases, your Network Representative will conduct a site visit within 60 days. There may be instances in which the Manager of Network Management requests a site visit for issues related to the quality, safety, or accessibility of a practitioner office that do not exceed the threshold of two or more cases. Site visits may require further action on the part of the provider/office. Martin's Point will work with you to ensure that we are providing quality, safe, and accessible care to our members. If you have questions or would like more details, please call 1-800-348-9804.

Communications and Education

Our network newsletter, The Point, is mailed to each participating provider office. The Point provides important updates about our health plans, health outcomes, benefits, billing, claims, quality measures, survey results, and more. We also offer a range of provider education services, including free seminars across our service area.

Sign up to receive our newsletter, The Point!