Provider Online Services FAQs

What data on Mutual Medical Plans cardholders is available to providers in electronic format?

The healthcare industry has adopted electronic transaction set 270/271 to communicate member eligibility and benefits, and transaction set 276/277 to inquire regarding the status of a claim. There are several ways that you as a provider can access this information including websites that aggregate this data on behalf of several payers, as well as provider practice management computer systems equipped to send and receive these electronic transactions with little human interaction. Providers unfamiliar with these transactions should contact their information technology department to find out if they are supported.

Our provider systems do support the 270/271 and 276/277 transactions. How do I start communicating electronically with Mutual Medical Plans?

Mutual Medical Plans data is routed through the clearinghouse Experian Health OneSource. Providers who currently have a business relationship with Experian should request access to Mutual Medical's data. If your company utilizes another Clearinghouse or Revenue Cycle Management Company please ask them if they have a relationship with Experian. Once access is granted, electronic inquiries may be submitted via Experian in the normal fashion.

Providers who currently access one of the Experian products for eligibility or other EDI transactions and want access to Mutual Medical's data can contact them at 866-854-5657.

Our practice uses a clearinghouse other than Experian Health (e.g. Emdeon, TransUnion.) Can I still access membership and claim data for Mutual Medical Plans?

Yes. Experian can coordinate passing of the 270/271 and 276/277 transactions through other clearinghouses. For assistance, contact an Account Manager with your Clearinghouse to discuss integration with Experian Health OneSource.

Is a web portal available to view membership and claim information online?

Our Provider Portal offers online access to eligibility, benefit and claim information for Plans administered by Mutual Medical Plans, Inc.  To register for an account or log-in, visit the Provider Portal homepage.

Additional web tools are available to providers who have a business relationship with Experian. Other Clearinghouses or Revenue Cycle Management companies that work with Experian may also provide web access to Mutual Medical Plans' data.  To learn more about the products offered by Experian, contact their sales department at 888-661-5657.

I would like to speak to a representative to verify a specific member's eligibility or the status of a claim. Who do I contact?

Telephone inquiries should be directed to Mutual Medical Plans at 309-674-0888.

Fax inquiries may also be sent to 309-674-5420.

When sending eligibility and claim status inquiries to Mutual Medical Plans, what ID number should be included in the electronic transaction?

Plans administered by Mutual Medical typically utilize one of two member identifier schemes.

  • Some plan participants are identified by a 1-3 character alpha prefix followed by the insured's Social Security Number (e.g. ABC123456789 where the Social Security Number is 123-45-6789)
  • Some plans utilize completely arbitrary identifiers (e.g. ABC56486315)

The type of identifier used is stated on the member's ID card.

In most cases, the member's Social Security Number (employee, spouse or dependent) may also be used for inquiries. No special characters (--, /, +, =) should be included in any of the IDs.

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