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Get Meridian Form 30 2013-2023
Set up with central pay. The central pay PSAO is eligible to receive EFT. If you are an affiliate of a PSAO utilizing central pay and would like to change your payment to EFT, you will need to contact your PSAO directly. PART I: REASON FOR SUBMISSION New EFT Authorization Cancel EFT Revision to Existing Enrollment (e.g. account or bank changes) Enroll in Electronic Remittance Advice (ERA) to Receive 835 Transmissions PART II: PHARMACY/ORGANIZATION INFORMATION Tax ID: Chain C.
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Certifies FAQ
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The Meridian Medicaid Plan is a Medicaid managed care health plan in Illinois. We connect Medicaid beneficiaries to the care that they need. Our plan is part of HealthChoice Illinois.
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If you aren't sure if your Medicaid coverage has been approved yet or if it is still active, you can check Manage My Case or call the state's Automated Voice Recognition System (AVRS) at 1-855-828-4995 with your Recipient Identification Number (RIN).
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We're here to help. Just call Meridian Member Services at 866-606-3700 (TTY: 711).
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Call the DHS Customer Service Helpline for assistance at: (800) 843-6154 voice/(866) 324-5553 TTY, Monday through Friday, 8:00 a.m. to 5:30 p.m., except state holidays. Where can I find official DHS forms?
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Please call Meridian Provider Services at 866-606-3700.
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