Contracting + Credentialing
CoOportunity Health utilizes Midlands Choice for provider network contracting and credentialing services.
In Iowa and Nebraska, 97 percent of physicians and 100 percent of hospitals are Midlands Choice contracting providers.
- Already participate with Midlands Choice? You’ve completed the contracting and credentialing process.
- Wish to participate? Contact Midlands Choice to complete the contracting and credentialing process.
- Unsure of your status? Contact Midlands Choice.
CoOportunity Health Plan Networks
- CoOportunity Premier– This preferred provider organization (PPO) product uses the Midlands Choice network of contracted providers.
- CoOportunity CorePlus UI Health Alliance – This new select network provider organization (PPO) product is available in 64 Iowa counties for 2015. The CorePlus network is a subset of Midlands Choice providers which includes the University of Iowa Health Alliance member organizations and other select providers. CorePlus includes out-of-network benefits for providers who are not a part of this subset.
- CoOportunity Preferred UI Health Alliance– This exclusive provider organization (EPO) product uses same network of providers as CorePlus (as described above) and is available in 64 Iowa counties for 2015. There are no benefits outside of the Preferred UI Health Alliance network except necessary emergency care.
- CoOportunity Choice UI Health Alliance – This open access three-tier product is available only in Iowa.
- Tier 1 consists of a subset of Midlands Choice facilities and physicians who are part of the University of Iowa Health Alliance and other select providers. This is the same subset of Midlands Choice providers designated as in-network for CorePlus and Preferred in 2015.
- Tier 2 includes Midlands Choice providers who are not a part of the Tier 1 subset described above.
- Tier 3 (out-of-network) includes providers who are not contracted with Midlands Choice.
To learn more about our products and how they work, see A Brief Overview of Our 2015 Products fact sheet.
Questions and Answers
Q1: How do I know if I participate with CoOportunity Health?
A1: As a Midlands Choice contracted provider, you participate in the provider network for these CoOportunity Health plans:
- CoOportunity Premier
- CoOportunity Choice (as Tier 1 or Tier 2)
If you are a Tier 1 Choice provider based on your designation with CoOportunity Health, you are also an in-network provider for CorePlus and Preferred.
Please contact Midlands Choice if you are unsure of your contracting status with them, or check our Provider Directory to determine your network status for each product.
Q2: When I enter our organization’s name in the provider directory, it says no results.
A2: Most Midlands Choice providers are listed in the Premier and Choice provider directories. If your name isn’t found in these provider directories:
- Enter a portion of your last name.
- Check the accuracy of selected search features, such as place of care or caregiver.
- Search by area and a parameter other than name, such as specialty or condition.
- Contact Member Services at 1.888.324.2064 for assistance.
Q3: Why does the back of the ID card say PHCS and MultiPlan?
A3: If members need care outside of Iowa, Nebraska, or South Dakota, we encourage them to use providers in the PHCS Network or the MultiPlan Network. These out-of-area providers are considered in-network for Premier, Tier 2 for Choice, and out-of-network for CorePlus and Preferred.
Q4: Who takes care of credentialing?
A4: Midlands Choice credentials healthcare providers. Contact Midlands Choice if you need to complete the credentialing or recredentialing process.
Q5: Where do we send our facility or practice changes?
A5: Notify Midlands Choice of changes 30 days before they are effective:
- For location and Taxpayer Identification Number (TIN) changes, use the Midlands Choice online Demographic Update Form. The online form is easy to use, ensures submission of all necessary information, and provides you with written confirmation of the form’s submission.
- When providers change their names (including practice names), become certified for additional specialties, or acquire new degrees, e-mail Midlands Choice using their online credentialing form.
Q6: Where do we find utilization management requirements and your Policy Manual?
A6: Use the following links to access information, available on both our secure and public Provider website: