PHO Contracts

In 2010, MGO became clinically integrated via Health⁴. All future contracts will utilize this model. MGO’s Board, participating physicians and management team are committed to this contracting model because it achieves healthier outcomes, lowers costs and demonstrates the value of MGO physicians to the purchasers of health care.

Payer contracts previously entered into via the messenger model will continue to be available until they are converted to Health⁴ contracts at the time of their renewal over the next 3 years.

All contracts, including Health⁴, are OhioHealth Group contracts. OhioHealth Group, a Physician Hospital Organization (PHO), is 50/50 owned by MGO and OhioHealth.

Delegated Credentialing

MGO is NCQA certified for Credentialing and Recredentialing and has been since 2003. As a result, credentialing is delegated to MGO for all PHO contracts. Physicians do not need to complete separate credentialing applications for each MGO contract in which they participate. MGO has contracted with OhioHealth Group Credentialing Services to perform the credentialing function. This provides practices with "one stop" credentialing for payer contracts and the OhioHealth hospitals. MGO reports credentialing information and all demographic changes to contracted payers on behalf of MGO physicians.

In addition, MGO also offers delegated credentialing for Mid-Level Practitioners employed by physician groups in Health⁴.The scope of Mid-Level Practitioners being credentialed includes Nurse Practitioners, Physician Assistants, Certified Registered Nurse Anesthetists, Nurse Midwives and Clinical Nurse Specialists.

Any changes in practice information, i.e. new address, tax ID number, etc. should be reported on the Physician Office Change Form. Using this form will help assure more accurate and timely notification of changes to all appropriate entities.

Administrative Assistance

MGO staff helps practices resolve payer problems. Practices that have been unable to resolve problems with claims, participation status or other issues should contact MGO. When contacting MGO please be prepared to provide as much detail as possible to enable MGO to assist you. It is helpful to know the nature of the problem, what steps you have taken to resolve the problem and who you spoke to at the payer.

Current Health⁴ contracts:

Aetna

Cigna (including Great-West Healthcare)

HealthReach Preferred

Medical Mutual of Ohio

Meijer

Current messaged contracts:

Accountable Health Plan of Ohio (AHPO)	Interplan Health Group (IHG)
Beechstreet	Ohio Preferred Network (OPN)
ChoiceCare	Ohio Health Choice PPO
Emerald Health	PPOM (Cofinity)
First Health

For more information about these payers please see Administrative Rules.

To learn more about MGO PHO contracts or to ask specific questions please click here to contact our staff.