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Polk HealthCare Plan Providers

Your role as a provider in the Polk HealthCare Plan network is essential to the health of our members. We are committed to providing you with resources and updates that will support our partnership and your efforts to serve plan members. We’re glad to have you in the network in providing indigent healthcare to our residents.

Interested in becoming a provider in the Polk HealthCare Plan network?

Eligibility and Benefit Verification

Eligibility must be verified by calling Customer Service (863) 533-1111 and benefits and claims information must be verified by calling Meritain Health, Inc. at (888) 850-8222. PHP members should provide their medical enrollment card at the time of their visit.

For eligibility and benefit information, when you call you will need to:

Note: Meritain can only quote visits already accumulated toward the 20-visit limit based on claims received and processed.

Provider Quick Reference
Service(s)Visit Limits Per Plan YearApprovals
Primary CareUnlimitedNo Pre-Cert Required
Specialist20 Visit Limit (does not refer to procedures)PCP Referral Required
CT Scans4 Visit LimitNo Pre-Cert Required
MRI/MRA*3 Visit Limit Combined MaxNo Pre-Cert Required
PET Scan2 Visit LimitNo Pre-Cert Required
Ultrasound6 Visit LimitNo Pre-Cert Required
Physical Therapy, Occupational Therapy and Speech Therapy36 Visit Limit Combined MaxNo Pre-Cert Required

*Visit Limit Combined Maximum refers to a grouping of services or therapies, in which the number of total visits for each service or therapy should NOT exceed the number of combined visit limits.

Referrals and Precertification

All member referrals MUST be to a provider or specialist within the Polk HealthCare Plan provider network. Referral forms are not required for diagnostic treatment, such as X-rays, MRIs, Ultrasounds, etc., or occupational, physical or speech therapies. A prescription from the referring provider is all that is required.

Refer to a network provider group, rather than a specific provider within the group. If referring the member to a specific provider, the member may only see the specified provider.

Only one referral per member per plan year (October 1 to September 30) is needed.

Referrals should be submitted prior to claim submission. Do not submit referrals with the claim.

Specialist Referring Specialist

If a Specialist refers to a Specialist, the referring Specialist must provide the Specialty Referral form.

The Provider/Specialist who receives the patient referral must submit the completed Specialty Referral form to: Meritain Health, Inc. via fax at (602) 789-9369 or submit via email at in order for claims to be paid.

To obtain a Provider Directory or Specialist Directory please contact Provider Services (863) 534-5377.

Primary Care Provider Specialist Referral

Referrals to Specialists must come from the member’s Primary Care Provider (PCP). The referring PCP must submit the Specialty Referral Form to the specialist’s office for the member to see a specialist.


All items listed on the precertification list must be authorized prior to service delivery.

Precertification requests should be faxed to American Health Holding (AHH) at (844) 241-9075 and questions about requests should be directed to AHH at (866) 353-6506.


Claim Submission

Claims may either be mailed to Meritain Health, P.O. Box 853921, Richardson, TX 75085-3921 or submitted electronically to EDI: WebMD/Emdeon 41124 or McKesson/Relay Health 1761.

Claims Appeals

Please mail all claims appeals to: Meritain Health, Appeals Department, P.O. Box 41980, Plymouth, MN 55441-0970

Polk HealthCare Plan Provider Directories

Please notify PHP Provider Services at (863) 534-5377 regarding changes in office location, phone, fax, or provider additions and eliminations. If the correct information is not on file, claims will be denied.

Lab Services

All blood work must go through Laboratory Corporation of America only. All pathology must go to Laboratory Corporation of America or Micro Path Labs only.


Simple bone and joint X-rays may be done in your office if available. If not available at your office, the member must go to one of our contracted radiology groups.