Member Review and Intervention Program (MRIP)

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The Member Review and Intervention Program (MRIP) is for Healthy Options, SCHIP, and Disability Lifeline enrollees only. It is a Community Health Plan program designed to control overutilization and inappropriate use of medical services by patients. This program allows restriction of patients to certain providers, including primary care providers (PCPs), pharmacies, and hospitals. Washington Administrative Code covering MRIP (WAC 388-501-0135) establishes the Patient Review & Coordination (PRC) program and allows managed care organizations to perform this function.

MRIP focuses on the health and safety of these patients, who are often seen by several different prescribers, have a high number of duplicate medications, use several different pharmacies, and have high emergency room usage. Based on clinical and utilization findings, patients are placed in MRIP for at least two years.

The Role of the Primary Care Provider in MRIP

The PCP plays a key role in managing the patient’s health care. When a patient is restricted, the patient's PCP must approve any care that patient receives from other practitioners or specialists, which may include prescriptions for scheduled drugs (CII–CV).

A major focus of MRIP is to educate the patient about:

  • Appropriate use of services
  • Relevance of office visits
  • Accessing resources in the community and within DSHS
  • The importance of maintaining one provider to manage and monitor one’s health care

Patients who are currently under review for the MRIP program will have an "MRIP" blue hyperlink displayed in the "My Patients" view in the Care Management Portal.

MRIP Documents:

The Role of the Pharmacy in MRIP

The primary pharmacy is a key player in managing the patient’s prescriptions. The pharmacist will be able to alert the patient’s PCP, the Community Health Plan MRIP staff, or DSHS’ PRC staff of misuse or potential problems with the patient’s prescriptions.

All pharmacy policies remain in effect. However, if the patient goes to a nonassigned pharmacy for scheduled drugs (CII–CV), the claim will be rejected.

The pharmacist may refer the patient back to their assigned pharmacy, or may choose at their discretion to fill the prescription drug and ask the patient to pay cash. However, patient reimbursement by Community Health Plan is not guaranteed.

The Role of the Hospital in MRIP

The hospital, particularly the emergency room staff, is a key player in assisting the patient’s PCP to more effectively manage the patient’s care to avoid unnecessary and costly services, especially emergency room services. By being aware of the patient’s restriction, the hospital can assist in the coordination of care by referring the patient back to their PCP and/or pharmacy, whether treatment is provided or not.

We welcome referrals. Please contact us at:
Member Review and Intervention Program (MRIP)
Community Health Plan
720 Olive Way, Suite 300
Seattle, WA 98101
Phone 206-521-8833

Enrollees may self refer to the program by calling Customer Service: for State programs, 1-800-440-1561, 8 am to 5 pm Monday through Friday); for Medicare programs, 1-800-942-0247, 8 am to 8 pm every day. Voicemail may be left after hours.