Producers

Producers

Membership Bonus
Managed HealthCare Northwest, Inc. recognizes the vital service that producers provide their group clients during the selection of employee medical plans.

As a reward for including either MHN PPO or CareMark PPO networks in sold group medical plans, we will pay a one-time new group business bonus. Simply complete the Producer Bonus Application Form and W-9 form return to us for payment. You may submit your application and W-9 using our on-line form, or simply print the forms and send to us via fax or mail.

Click here for our convenient on-line form
MHN Overview
Managed HealthCare Northwest, Inc. is based in Portland, Oregon and is owned by Legacy Health and Adventist Medical Center. MHN was formed December 1, 1988 through the merger of CareMark Services and Northwest Health, Inc. MHN is an Oregon for-profit corporation.

Service Area

CareMark PPO and MHN PPO represents one of the most broadly based networks in the greater Portland-Vancouver area including:

Oregon State Counties:
Multnomah, Clackamas, Washington, Columbia, Hood River, Lane, Marion, Polk, Wasco, Yamhill, and Coos.
* Coos county includes 1 hospital and limited physician access

Washington State Counties:
Clark, Cowlitz, Skamania, and Klickitat.

PPO Panel

The Professional Provider Network is comprised of 4,757 physicians and other professionals, including 1228 primary care physicians and represents 80 medical specialties. Of MHN's providers, 69% of the PCP's and 78% of the specialists are board certified. The panel is currently closed, unless a specific demographic access or specialty is needed.

The Hospital Network is comprised of 21 facilities, including two premier tertiary care (highly specialized, high technology) facilities: Legacy Emanuel Medical Center, and Legacy Good Samaritan Medical Center.

Managed Care Plan Options

MHN’s full spectrum of managed care services can be integrated into the employer's existing gatekeeper or point-of-service plan design, whether insured or self-funded. Utilization-Quality Management services can be provided in a complete package, or Utilization-Quality Management and Claims Re-Pricing can be purchased separately. There are currently more than 125,000 members in CareMark PPO and MHN PPO.

Cost Effective

MHN delivers high quality health care by means of stringent physician credentialing and peer monitoring systems. Costs are controlled by ensuring care is medically necessary and given in the appropriate setting - as well as by negotiated provider discounts.
Products

CareMark PPO Services include:

  • Hospital and Physician Panel
  • Medical Management
  • Re-pricing Network Claims

MHN PPO Services include:

  • Hospital and Physician Panel
  • Hospital Panel Only
  • Physician Panel Only
  • Re-pricing Network Claims

Medical Management:

  • Pre-certification of hospitalization and surgery for medical necessity
  • Concurrent and retrospective review
  • Complex case management
CareMark Comp Workers' Compensation MCO

Directories

Please contact the MHN Marketing Department for administrative fees and other information at (503) 413-5800.
Health Insurers

Health Insurers

  • PacificSource Health Plans (minimum 2)
  • (503) 699-6561

Individual Insurers

  • Assurant Health
  • (800) 884-6875

PacificSource Health Plans

  • (800) 624-6052
Third Party Administrators
Side-by-Side PPO
Could your employer clients improve profits by increasing employee PPO utilization?

Would employees enjoy the opportunity to select family physicians from a second PPO network?

If so, Managed HealthCare Northwest, Inc. offers the needed flexibility! MHN will share an employer group with a competing PPO network - for new business - with no minimum enrollment requirement.

MHN will still require each employee to enroll his/her family in one PPO of choice. As before, the claims payor reports to us employees who have selected MHN PPO or CareMark PPO.

The claims payor would pay the monthly administrative fee to MHN for only those employees who have enrolled themselves and their families in our PPO - and issues MHN PPO or CareMark PPO I.D. cards (as applicable) to these employees.

If our flexibility can save money and expand access for your clients, please call the Marketing Department at (503) 413-5800. We can also be reached by e-mail at the following addresses:

Jody Ordway - Sales Manager
Reciprocal PPO Arrangements

National PPO's

Beech Street Corporation / CAPP CARE
1-949-955-6245
Value Added Services

Administrative

Provider Relations Consultants Experienced, cross-trained staff

  • Assist with physician selection
  • Identify network services
Marketing Consultants Experienced, insurance licensed staff

  • Supply bid analysis, geo access and references
  • Assist with enrollment and employee health fairs
  • Complimentary PPO savings reports
Optional Medical Management Services Licensed, professional RNs and MDs

  • Detailed Bill Review
  • Medical Case Management
    • Group Health
    • Workers' Compensation
  • Advisory Medical Necessity review

Network

4,757 Physicians and other professionals Stringently credentialed, peer monitored
Multi-lingual availability
21 Hospitals Community owned
JCAHO accredited
Complimentary health education
Community philanthropy
Urgent Care Facilities 20 Conveniently located

Communication

Receptionist Personal call direction
Local phone (503) 413-5800
Toll free phone outside Portland area: 1-800-648-6356
Voice Mail 24 hour
E-mail access All staff
Bulletins Quarterly for customers and brokers

Directories

Directories and shipping Complimentary
Same day delivery available
Annual drop-shipment of newest directory direct from the printer to payors and employers
Website Printable, on-line listings