PAM Section 1: Introduction

On this page:

• About Mount Carmel MediGold Health Plan
• Important News and Updates to this Manual
• Provider Communications
• How to Contact the Plan
• Additional Resources

About Mount Carmel MediGold Health Plan

Mount Carmel MediGold Health Plan is a Medicare Advantage plan. We are a provider-sponsored organization dedicated to providing exceptional coverage, customer service and access to high quality and cost-effective care.

We are a not-for-profit organization that is a part of the Trinity Network and are contracted with the Centers for Medicare & Medicaid Services (CMS) to participate in the Medicare Advantage program offering HMO products with, and without, Part D drug coverage to Medicare beneficiaries. 

We are committed to partnering with our providers to build strong relationships and make working with us easier. We developed this manual to guide you through Mount Carmel MediGold Health Plan policies, procedures and processes. Great effort has been made to ensure the information in these pages is accurate. If there is any conflict between the contents of this manual and your provider agreement, the provider agreement will prevail. Please contact provider services if you have any questions.

Important News and Updates to this Manual

In accordance with your agreement, providers must abide by all provisions contained in this manual, as applicable. Revisions to this manual constitute revisions to Mount Carmel MediGold Health Plan's policies and procedures. Such revisions and other updates to policies and procedures may be communicated to network providers via the monthly Provider Update, but may also be communicated via multiple methods that may include mail, internet, email, telephone, and in person.

Provider Communications

We want to be a great partner and develop mutually beneficial partnerships with our providers. Communication is essential to successful relationships and sharing information with you is very important to Mount Carmel MediGold Health Plan. We distribute a monthly “Provider Update” to all our participating providers. It shares key information to stay current on matters that may affect your work with Mount Carmel MediGold Health Plan and our members.

How to Contact the Plan

Department Contact Information

Additional Resources

• Provider portal (for eligibility, claims and communications)
• Essette Provider Portal (for all utilization management functions)
• Commonly used forms
• Member Evidence of Coverage documents
• Member Formulary (Drug List)
• Centers for Medicare and Medicaid Services website
• Medicare Managed Care Manual

Last updated: 03/2024