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 SSI Claimsnet. Providers who currently have a business relationship with SSI can interact with Mutual Medical Plans' data by sending inquiries to Payer ID MMPHX. If your company utilizes another Clearinghouse or Revenue Cycle Management Company please ask them if they have a relationship with SSI.
Our practice uses a clearinghouse other than SSI Claimsnet (e.g. Experian, Change Healthcare.) Can I still access membership and claim data for Mutual Medical Plans?
Yes. SSI 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 SSI Claimsnet.
Our system cannot send and receive these transactions. Is there another way to obtain benefits and claim status information?
Our web-based 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.
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?
For the best results, the inquiry should be submitted with a primary Member ID which matches the subscriber's Social Security Number. Spouses use the subscriber's Social Security Number with a suffix of -S1. Dependent children use the subscriber'sSocial Security Number with a suffix of -C1 for the oldest child, -C2 for the second oldest, etc.
Example:
- Subscriber / employee Social Security Number is 111-22-3333. Submit inquiry with Member ID of: 111-22-3333
- Spouse Member ID: 111-22-3333-S1
- Child Member ID: 111-22-3333-C1, 111-22-3333-C2, and so on.
Note that these numbering schemes may not match what is indicated on the Member ID card. For privacy purposes, many members have alternative ID cards indicated on their cards. However, use of the Social Security Number is required to yield the best results from EDI inquiries. Claims may be submitted under either ID.