We must tell you in writing why we will not pay for or approve a prescription drug or Part C medical care or service, and how you can file an appeal to ask us to change this decision. Phcs Insurance Provider Phone Number | TheWebster Miami In-office procedures are restricted to a specific list of tests that relate to the specialty of the physician. Glaucoma screening Occasionally, these complaints relate to the quality of care or quality of service members receive from their PCP, specialist, or the office staff. Provider. For preauthorization of the following radiological services, call 877-607-2363 or request online atradmd.com/. Most plans exclude purely dental services, including oral surgery, but benefits vary by employer. There are exceptions allowed or required by law, such as release of health information to government agencies that are checking on quality of care. Question 1. Remember, it is your choice whether you want to fill out an advance directive (including whether you want to sign one if you are in the hospital). Your right to get information about our plan, plan providers, drugs, health care coverage, and costs. We may enroll employer group members as well. PHCS is the leading PPO provider network and the largest in the nation. UHSM is NOT an insurance company nor is the membership offered through an insurance company. You also have the right to give your doctors written instructions about how you want them to handle your medical care if you become unable to make decisions for yourself. After the Plan deductible is met, benefits will be covered according to the Plan. Members under 12 years of age call PHC's Care Coordination Department at (800) 809- 1350. For a specific listing of services and procedures that require pre-authorization refer to the Appendices within this manual. In addition, the ID card also includes emergency instructions and a toll-free telephone number for out-of-area and after-hours notifications, the Member Services phone number, and the claims submission address. A candid discussion of appropriate or medically necessary treatment options for your condition, regardless of cost or benefit coverage. In this section, we explain your Medicare rights and protections as a member of our plan and, we explain what you can do if you think you are being treated unfairly or your rights are not being respected. Colorectal screening (age restrictions apply) Simplifying the benefits experience, so you can focus on patient care. PHCS (Private Healthcare Systems, Inc.) - PPO. If you are admitted to the hospital, they will ask you whether you have signed an advance directive form and whether you have it with you. Each members enrollment is generally in effect as long as the member chooses to stay in ConnectiCare. The service area includes all counties in Connecticut. Your responsibilities include the following: Getting familiar with your coverage and the rules you must follow to get care as a member. The right to know how information about race, language, ethnicity, gender orientation, and sexual identity are collected and used. To get this information, call Member Services. UHSM is excellent, friendly, and very competent. Although not a provider of health insurance, PHCS is a provider of PPO (Preferred Provider Organization) networks. ConnectiCare members will receive an identification (ID) card when they enroll in the plan. New users to the Provider Portal can create an account by selecting the Provider Access Link on the portal login page. Members pay a copayment cost-share for most covered health services at the time the services are rendered. As always, confirm benefits by contacting Provider Services at 877-224-8230. First, try the Eligibility and Referral Line, If unable to verify, then call Provider Services, (You must participate with Medavant to utilize services). High Deductible Health Plan (Health Savings Account [HSA] Compatible). Continuity of Care allows members the option to apply to receive services at in-network coverage levels for specified medical and behavioral conditions, from their current health care provider if the provider is or is soon to be out-of-network. plan. Pleasant and provided correct information in a timely manner. Identify the state legal authority permitting such objection; Once submitted, ConnectiCare will verify the eligibility of the member with the Centers for Medicare & Medicaid Services (CMS) as they are the sole arbiter of eligibility for Medicare. Welcome to the MultiPlan Provider PortalThe portal lets you view and update your network-related information, manage tasks such as credentialing and track your customer service case history. Some plans may have a copayment requirement for radiology services. Your Explanation of Payment (EOP) will specify member responsibility. Note: To ensure accurate billing for plans with deductibles, bill ConnectiCare prior to taking any payment from members. Members are encouraged to actively participate in decision-making with regard to managing their health care. This would also include chronic ventilator care. If transport is required from one facility to another on a weekend or holiday, transport must be provided by a participating service. Medicare and Medicaid eligible members designated as Qualified Medicare Beneficiary. Note: These procedures are covered procedures, but do not require preauthorization in network. In addition, the following guidelines apply: The following are covered preventive care services: Please note there are designated frequencies and age limitations. Please Note: When searching for providers, the results presented are for reference only; as participating physicians, hospitals, and/or healthcare providers may have changed since the online directory was last updated. PHCS / Multiplan Provider Search for CommunityCare Life & Health PPO Please refer to your Membership Agreement, Certificate of Coverage, Benefit Summary, or other plan documents for specific information about your benefits coverage. Document in a prominent part of the individual's current medical record whether or not the individual has executed an advance directive; and The following are samples of each type of ID card that ConnectiCare issues to members. (214) 436 8882 Members with End Stage Renal Disease (ESRD) will not qualify, except if they are currently covered by a ConnectiCare benefit plan through an employer or self pay (a commercial member). It is not medical advice and should not be substituted for regular consultation with your health care provider. How do I know if I qualify for PHCS insurance? ConnectiCare's policies must show evidence of respecting the implementation of their rights, including a clear and precise statement of limitation if ConnectiCare and its network of participating providers cannot implement an advance directive as a matter of conscience. Life Insurance *. All oral medication requests must go through members' pharmacy benefits. Claims or Benefits questions will not be answered here. In addition, to ensure proper handling of your claim, always present yourcurrent benefits ID card upon arrival at your appointment. Some preventive services are covered at 100% and are exempt from the deductible requirement. ConnectiCare will communicate to your patients how they may select a new PCP. MultiPlan uses technology-enabled provider network, negotiation, claim pricing and payment accuracy services as building blocks for medical payors to customize the healthcare cost management programs that work best for them. If you have questions or concerns about your rights and protections, please call Member Services. If you have any questions please review your formulary website or call Member Services. Bone mass measurement Medicare members may disenroll from the plan when the guidelines, as set forth bythe Centers for Medicare & Medicaid Services (CMS), are met. According to law, no one can deny you care or discriminate against you based on whether or not you have signed an advance directive. Members have an in-network deductible for some covered services. If you have any questions regarding a member's eligibility, call Provider Services at 877-224-8230. Lifetime maximums apply to certain services. The provider must agree to accept network rates for the defined period of time. Follow the rules of this Plan, and assume financial responsibility for not following the rules. Initial mental health consultation Their services are offered to health care plans, not individuals, as they do not sell insurance or offer any medical services. Use our online Provider Portal or call 1-800-950-7040. The ConnectiCare Medicare Advantage network. The laws that protect your privacy give you rights related to getting information and controlling how your health information is used. You will get most or all of your care from plan providers, that is, from doctors and other health providers who are part of our plan. ConnectiCare enrolls individual members into the ConnectiCare plan. No referrals needed for network specialists. Customer Service at 800-337-4973 part 91; other laws applicable to recipients of federal funds; and all other applicable laws and rules, are required by applicable laws or regulations. After the deductible is met, benefits will be covered according to the Plan. Coverage follows Original Medicare guidelines. Such information includes, but is not limited to, quality and performance indicators for plan benefits regarding disenrollment rates, enrollee satisfaction, and health outcomes. If you need more information, please call Member Services. For guidance in the prohibition of balance billing of QMBs, please refer to thisMedicare Learning Network document. You have the right to get information from us about our network pharmacies, providers and their qualifications and how we pay our doctors. TTY users should call 877-486-2048, or visit www.medicare.govto view or download the publication Your Medicare Rights & Protections. Under Search Tools, select find a Medicare Publication. If you have any questions whether our plan will pay for a service, including inpatient hospital services, and including services obtained from providers not affiliated with our plan, you have the right under law to have a written/binding advance coverage determination made for the service. Pharmacy cost-share, if applicable. Your rights include knowing about all of the treatment options that are recommended for your condition, no matter what they cost or whether they are covered by our plan. Regardless of where you get this form, keep in mind that it is a legal document. We must investigate and try to resolve all complaints. Christian Health Sharing State Specific Notices. ConnectiCare reserves the right to terminate coverage for members who repeatedly fail to make the required copayments, coinsurance or deductibles, subject to the terms outlined in the applicableMember Agreement, Evidence of Coverage, or other governing contract. Providers - INSURANCE BENEFIT ADMINISTRATORS Members who develop ESRD after enrollment may remain with a ConnectiCare plan. UHSM Providers - PHCS PPO Network Just like we shop for everything else! On a customer service rating I would give her 5 golden stars for the assistance I received. Visit Performance Health HealthworksWellness Portal. If your plan does not meet the requirements below, Primary PPO Complementary PPO Specialty Networks Network Management Analytics-Based Solutions: Negotiation Services Medical Reimbursement You should consider having a lawyer help you prepare it. This includes information about our financial condition and about our network pharmacies. After the deductible has been met, coinsurance will apply to the covered benefits. Monitoring includes member satisfaction with physicians. No specialist-to-specialist referrals permitted, except OB/GYNs may make referrals. They will be clearly distinguishable by their ID cards. However, the majority of PHCS plans offer members . Access to any Medicare-approved doctor or hospital in the United States. Provider Portal Point-of-Service High Deductible Health Plans have an additional Plan deductible requirement for services rendered by non-participating providers. You have the right to be told about any risks involved in your care. Yes, PHCS provides coverage for therapy services. For the PHCS Network, 1-800-922-4362 For PHCS Healthy Directions, 1-800-678-7427 For the MultiPlan Network, 1-888-342-7427 For the HealthEOS Network, 1-800-279-9776 For language assistance, please call 1-866-981-7427 For TTY/TTD service, please call 1-866-918-7427 Search for a provider > UHSM medical sharing eligibility extends to qualifying costs at the more than 1.2 million doctors, hospitals, and specialists in this network. Our goal is to be the best healthcare sharing program on the planet and to providean AWESOME*experience, every time! If you have signed an advance directive, and you believe that a doctor or hospital hasnt followed the instructions in it, you may file a complaint with: Connecticut Department of Health Your right to use advance directives (such as a living will or a power of attorney) These services are covered under the Option Plan nationwide. If you have questions about your benefits or the status of claims, please call Group Benefit Services, Inc. If you are a primary care provider (PCP), you may also check your most recentMembership by PCPreport. You have the right to an explanation from us about any bills you may get for drugs not covered by our Plan. MRI/MRA (all examinations) ConnectiCare members are entitled to an initial assessment of their health care status within ninety (90) days of enrollment in the Plan. The member engages in disruptive behavior. For example, you have the right to look at medical records held at the plan, and to get a copy of your records. To begin the precertification process, your provider(s) should contact Out of network benefits will apply when receiving care from non-participating providers. Members pay a copayment as cost-share for most covered health services at the time services are rendered. I'm a Broker. Admission to a SNF for rehabilitation, in the absence of a hospitalization or acute episode of illness, requires preauthorization and is subject to medical necessity review. Physicians are required to make referrals to participating specialty physicians, including chiropractic physicians. Box 340308 Hartford, CT 06134-0308 See preauthorization list for DME that requires pre-authorization. In addition, some of the ConnectiCare plans include Part D, prescription drug coverage. PDF PHCS Network Bringing Greater Choice and Savings to the Employees You should consider having a lawyer help you prepare it. Renal dialysis services for members temporarily outside the service area. Multiplan or PHCS | Mental Health Coverage | Zencare Zencare It is important to sign this form and keep a copy at home. * ConnectiCare reserves the right to use third-party vendors to administer some benefits, including utilization management services. Our plan must have individuals and translation services available to answer questions from non-English speaking beneficiaries, and must provide information about our benefits that is accessible and appropriate for persons eligible for Medicare because of disability. You have the right to go to a womens health specialist (such as a gynecologist) without a referral. They are used to assess health care disparities, design intervention programs, and design and direct outreach materials, and they inform health care practitioners and providers about individuals needs. Acting in a way that supports the care given to other patients and helps the smooth running of your doctors office, hospitals, and other offices. For emergency care received outside the U.S. there is a $100,000 limit. A new web site will open up in a new window. You have the right to get information from us about our plan. If you make a complaint, we must treat you fairly (i.e., not retaliate against you) because you made a complaint. Some plans may have deductible and coinsurance requirements. If you admit a member to a SNF on a weekend or holiday, ConnectiCare will automatically authorize payment for SNF services from the day of admission through the next business day. While other insurance companies and TPAs make you go through numerous frustrating prompts and then hold for an extensive period, our approach is to take the call as soon as possible so that you can move on with your day. 877-585-8480. PDF PHCS Savility - MultiPlan For benefit-related questions, call Provider Services at 877-224-8230. Testing that exceeds this maximum is the members responsibility. Savings - Negotiated discounts that result in significant cost savings when you visit in-network providers,helping to maximize your benefits. drug, biological or venom sensitivity. You also have the right to receive an explanation from us of any utilization management requirements, such as step therapy or prior authorization that may apply to your plan. Visit www.uhsm.com/preauth Download and print the PDF form Fax the preauth form to (888) 317-9602 GET PREAUTH FORM member-to-member health sharing How Healthshare Works with UHSM, it's Awesome! These members may have a different copayment and/or benefit package. Accessing PHCS Savility PHCS Savility is available to insurers and benefit plan administrators meeting certain benefit design You also have the right to give your doctors written instructions about how you want them to handle your medical care if you become unable to make decisions for yourself. PCPs:Advise your patients to contact ConnectiCare's Member Services at 800-224-2273 to designate a new PCP, even if your practice is being assumed by another physician. Popular Questions. You have the right to timely access to your providers and to see specialists when care from a specialist is needed. Notifying providers when seeking care (unless it is an emergency) that you are enrolled in our plan and you must present your plan enrollment card to the provider. You may also use the ConnectiCare Eligibility and Referral Line. To determine copayment requirement, call ConnectiCare's Eligibility & Referral Line at 800-562-6834. Coverage for skilled nursing facility (SNF) admissions with preauthorization. Emergency care is covered. These plans, sometimes called "Part C," provide all of a member's Part A (hospital coverage) and Part B (optional medical coverage) coverage and offer extra benefits too. Note: Some services require preauthorization. Postoperative physical therapy for TMJ surgery is limited to ninety (90) days from the date of surgery when pre-authorized as part of surgical procedure. Not condition the provision of care or otherwise discriminate against an individual based on whether or not the individual has executed an advance directive. Your right to get information about our plan and our network pharmacies That goes for you, our providers, as much as it does for our members. ConnectiCare also makes available to members printable, temporary ID cards via our website. Generally, we must get written permission from you (or from someone you have given legal power to make decisions for you) before we can give your health information to anyone who isnt providing your care or paying for your care. abnormal arthrogram. Go to the Client Portal > Provider directories Create a customized listing of facilities and/or practitioners participating in the network services offered by MultiPlan. Referrals must be signed in ConnectiCares referral system viaProvider Connection. Screening pap test. Eligibility and Referral Line Please note that your benefits and out of pocket expenses may vary when using PHCS providers. In order to maintain permanent residence, a member must not move or continuously reside outside the service area for more than 6 consecutive months. PHCS PPO Network - Health Depot Association Nutritionist and social worker visit For more information or assistance specific to our portal, please call MultiPlan Customer Service at 1-877-460-0352. View the video below for additional information on the MyMedicalShopper pricing tool: The Member Resource Document includes details for your reference on: You can reference your plan document for the complete list. Your right to the privacy of your medical records and personal health information. SeeMedical Management. Question 4. You can sometimes get advance directive forms from organizations that give people information about Medicare. You must call ConnectiCares Notification Line at 860-674-5870 or 888-261-2273 to advise ConnectiCare of the admission. The ID card lists the following information: ConnectiCare member ID number Following is the statement in its entirety. Providers are responsible for seeking reimbursement from members who have terminated if the services provided occurred after the member's termination date. Simply call (888) 371-7427 Monday through Friday from 8 a.m. to 8 p.m. (Eastern Standard Time) and identify yourself as a health plan participant accessing PHCS Network for Limited Benefit plans. You should give a copy of the form to your doctor and to the person you name on the form as the one to make decisions for you if you cant. P.O. It includes services and supplies furnished to a member who has a medical condition that is chronic or non-acute and which, at our discretion, either: Are furnished primarily to assist the patient in maintaining activities of daily living, whether or not the member is disabled, including, but not limited to, bathing, dressing, walking, eating, toileting and maintaining personal hygiene or. If you need help with communication, such as help from a language interpreter, please call Medicare Member Services. Go > 410 Capitol Avenue Submit a Coverage Information Form. Please note: The benefit information provided is not a comprehensive list and is subject to change. ConnectiCare will maintain such health information and make it available to CMS upon request, as necessary. (More information appears later in this section.). Services or supplies that are new or recently emerged uses of existing services and supplies, are not covered benefits, unless and until we determine to cover them. Letting us know if you have additional health insurance coverage. Broker benefits Get in touch. Coverage is provided for temporomandibular joint (TMJ) surgery or orthognathic procedures with preauthorization, when medical necessity is established. If you want to receive Medicare publications on your rights, you may call and request them at 1-800-MEDICARE (800-633-4227). Regardless of where you get this form, keep in mind that it is a legal document. Provide, to the extent possible, information providers need to render care. HPI | Provider Resources | Patient Benefits & Eligibility If you want to, you can use a special form to give someone the legal authority to make decisions for you if you ever become unable to make decisions for yourself. All providers shall comply with Title VI of the Civil Rights Act of 1964, as implemented by regulations at 45 C.F.R. Call us and tell us you would like a decision if the service or item will be covered. Preferred Provider Organization Questions? The member loses entitlement to Medicare Parts A and/or B. The rental and/or purchase of CPAP and BI-PAP machines must be done through our preferred vendors. Emergency care and out-of-area urgently needed services are covered under the Prime and Custom Plans, anytime, anywhere (worldwide). Thank you, UHSM, for the excellent customer service experience and the great attitude that is always maintained during calls. We request your cooperation in investigating and resolving these complaints. Member satisfaction with ConnectiCare is very important. What should I do if I get a bill from a healthcare provider? ConnectiCare will disclose to the Centers of Medicare & Medicaid Services (CMS) all information that is necessary to evaluate and administer our Medicare Advantage plans, and to establish and facilitate a process for current and prospective members to exercise choice in obtaining Medicare services. Refer members to the ConnectiCare Member Services at 800-224-2273 if they need information on disenrollment. Our plan must obey laws that protect you from discrimination or unfair treatment. If you have questions or concerns about privacy of your personal information and medical records, please call Member Services. This system requires that you have a touch-tone phone and know your ConnectiCare provider ID number, as well as the member's identification number, to verify eligibility. Additionally, ConnectiCaremaydisenroll a member if: Premiums are not paid on a timely basis. ThriveHealth STM - Health Depot Association To inquire about an existing authorization - (phone) 800-562-6833 For additional details on using ConnectiCare's Eligibility & Referral Line or Medavant, refer toAutomated & Online Features. Members have the responsibility to: Members rights and our obligations are limited to our ability to make a good faith effort in regard to: Each time a member receives services, you should confirm eligibility. You have the right to find out from us how we pay our doctors. The provider must agree to accept network rates for the defined period of time. You have the right to be treated with dignity, respect, and fairness at all times. You can also get help from CHOICES - your State Health Insurance Assistance Program, or SHIP. This means the PHCS Savility network offers the same quality for which PHCS Network has been recognized since 2001. We are required to provide you with a notice that tells about these rights and explains how we protect the privacy of your health information. Remember you will only need your registration code this one time to set up your account. Requests may be made by either the physician or the member. The bill of service for these members must be submitted to Medicaid for reimbursement. ConnectiCare will communicate to your patients how they may select a new PCP. Some applicable copayments You are now leavinga ConnectiCare website. For a specific listing of services and procedures that require preauthorization please refer to the preauthorization lists found within this manual. It is generally available between 7 a.m. and 9:30 p.m., Monday through Friday, and from 7 a.m. to 2 p.m. on Saturday. To verify benefits and eligibility - (phone) 800-828-3407, To inquire about an existing authorization -800-562-6833, To request a continuation of authorization for home health care or IV therapy (seeForms, to obtain a copy of the applicable form) - fax 860-409-2437. Initial chiropractic assessment Reminding the patient to notify ConnectiCare; and UHSM medical sharing eligibility extends to qualifying costs at the more than 1.2 million doctors, hospitals, and specialists in this network. My rep did an awesome job. You have the right to choose a plan provider (we will tell you which doctors are accepting new patients). Our contract with you for participation in the ConnectiCare program requires you to provide coverage 24-hours, seven days a week, including weekends and holidays. SISCO's provider portal allows you to submit claims, check status, see benefits breakdowns, and get support, anytime. Portal Training for Provider Groups Delays and failures to render services due to a major disaster or epidemic affecting our facilities or personnel. Specialists:Provide continuity and coordination of care by sending a written report to the member's PCP regarding any treatment or consultation provided to the member. If you need assistance If you encounter issues when scheduling appointments with PHCS Network providers, call us at 866-685-7427. For more information regarding complaint resolution, contact Provider Services at 877-224-8230. precertification on certain services. ConnectiCare Medicare Advantage plans include a number of Medicare Advantage Plans. Ask to see the member's ConnectiCare member identification (ID) card. Product and plan details are outlined in the product and coverage section on this page. Click on the link and you will then have immediate access to the Member portal. What services are available to me that could save me money? Member receive in-network level of benefits when they see PHCS Healthy Direction Providers. Timely access means that you can get appointments and services within a reasonable amount of time. We must investigate and try to resolve all complaints. What does Transition of Care and Continuity of Care mean? It is important to note that not all of the Sutter Health network . Please review the member's ID card to confirm the appropriate phone number. To get any of this information, call Member Services. Mail Paper HCFAs or UBs: Medi-Share Healthcare Provider FAQs > MultiPlan Your right to get information about our network pharmacies and/or providers Use your member subscriber ID to access the pricing tool using the link below. UHSM is a different kind of healthcare, called health sharing. Please note: MultiPlan, Inc. and its subsidiaries are not insurance companies, do not pay claims and do not guaranteehealth benefit coverage.
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