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Provider Manual



Delivering the best possible health care experience to our providers and patients.

Specific Provider Manual information can be found by accessing the menu below.

Care Management

Information about our care management services and health management resources.

Claims

Information about the claims process for health plan members.

Compliance

Information on the Martin's Point Compliance Program for employees and providers.

Credentialing

Information about provider and/or facility participation in our health plan networks.

Healthcare Effectiveness Data & Information Set

We use HEDIS to monitor our performance and identify areas for improvement.

Medical Record Requests & Documentation

How to request or maintain complete and accurate medical records.

Member Grievances & Appeals

Members have the right to file a grievance or appeal regarding coverage or quality of care.

Member Rights & Responsibilities

Rights and responsibilities of Martin's Point health plan members.

Membership & Eligibility

Eligibility information for all Martin's Point health plan members.

Policies

Information about our Benefit Policy, Medical Policy, and Payment Policy.

Prescriptions & Pharmacy

Plan formularies, pharmacy network, and drug coverage information.

Privacy & Confidentiality

Protecting confidential member and provider information from unauthorized disclosure.

Provider Demographics

Submit changes to provider, group, or practice information listed in our Provider Directory.

Quality

Delivery of care and services meeting the highest standards for effectiveness and safety.

Service Standards

Standards for patient service and communication, scheduling, and reporting.

Utilization Management

Clinical coverage decisions, prior authorizations, and patient referrals.

Glossary of Terms

A helpful guide to key words and meanings.

Contact Us

Speak with a Martin's Point representative.

About Martin's Point

About our organization and health plans.

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About Martin's Point Health Care

Martin’s Point Health Care (MPHC) is a progressive, not-for-profit, health care organization with experience and demonstrated excellence in both clinical patient care and health plan administration.

Understanding both aspects of our health care system (clinical care and payment) gives us unique insights that allow us to make meaningful improvements to the health care system. We bring together primary care providers, specialists, health plans, systems, and processes to deliver the best possible health care experience to each individual. This coordinated approach is designed to create more quality time with health care providers, greater consistency in care, and ultimately, lower overall costs to the system. 



Provider Manual content reviewed and updated as of January 1, 2026.


Please Note:
This manual is an extension of the participation agreement between MPHC and all network provider types including, but not limited to, physicians, hospitals and ancillary healthcare providers (“provider(s)”) and furnishes providers and their office staff with information concerning policies and procedures, claims, and guidelines used to administer MPHC health plans. This manual replaces and supersedes all previous versions. A paper copy may be obtained upon written request. In accordance with our participation agreement, all providers must abide by all provisions contained in this manual, as applicable. Revisions to this manual constitute revisions to MPHC’s policies and procedures. As policies and procedures change, updates will be issued and incorporated into subsequent versions of this manual.