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PHO Contracts
 
 
MGO has created its own "Pay for Quality" contracting model to change a current system that does not reward quality. MGO's program is unique. Physicians are provided actionable information through reports to assist them with caring for their patients. In conjunction, the employer (by example OhioHealth) is encouraging their employees to receive services through their health benefit structure plan.


This is an important step in creating a contract model that achieves healthier outcomes, lowers costs and demonstrates the value of MGO physicians to the purchasers of health care. At the same time, it also serves as the model on which MGO can build upon to achieve clinical integration.


As this new program continues to expand, MGO maintains its commitment to achieving the best results with third-party-payers for its physicians under the current Physician Hospital Organization (PHO) messenger model. The PHO, OhioHealth Group, is a 50/50 owned company between MGO and OhioHealth.


Contracting with Payers via OhioHealth Group PHO 

Through its partnership with OhioHealth, MGO is an equal owner of the OhioHealth Group, a physician-hospital organization (PHO).  MGO works with contracted payers to: 

  • Achieve reimbursement consistent with the panel of excellence of MGO physicians
  • Increase access to patients
  • Decrease hassle factor
  • Provide physicians simplified delegated credentialing 

Delegated Credentialing 

Credentialing is delegated to MGO for all PHO contracts. Physicians do not need to complete separate credentialing forms for the MGO contracts 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 practices.  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 work closely with practices and payers to facilitate communication and problem resolution.  In addition to maintaining a comprehensive and current list of Administrative Rules for each payer, 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 assist MGO with assisting 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.

MGO is currently contracted with the following Third Party Payers:

Aetna

Great-West HealthCare

Aetna Medicare

Humana

Beechstreet
Humana Medicare

CIGNA

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.


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More Info
 
  • Clinical Integration
  • Sample Fee Schedules
  • Medicare 2008
  • Administrative Rules
  • Physician Office Change Form
  • W-9
  • Credentialing Plan
  • Contact MGO Contracting