See the preauthorization section for a listing of DME that requires preauthorization. Answer 1. Examples of qualifying medical conditions can be found below. Refer members to the ConnectiCare Member Services at 800-224-2273 if they need information on disenrollment. PHCS www.multiplan.com (Please select the provider network listed on your ID card) For emergency care received outside the U.S. there is a $100,000 limit. ConnectiCare Medicare Advantage plans include a number of Medicare Advantage Plans. Check with our Customer Service Team to find out if your plan accesses Health Coaching. You have the right to get your questions answered. All requests to initiate or extend a mental health or substance abuse authorization should be directed to our Behavioral Health Program at 800-349-5365. You have the right to ask someone such as a family member or friend to help you with decisions about your health care. If so, they will follow up to recruit the provider. According to law, no one can deny you care or discriminate against you based on whether or not you have signed an advance directive. This information, reprinted in its entirety, is taken from the planEvidence of Coverage. By contracting with this network, our members benefit from pre-negotiated rates and payment processes that lead to a much smoother process and overall cost savings. The plan will release your information, including your prescription drug event data, to Medicare, which may release it for research and other purposes that follow all applicable Federal statutes and regulations. Emergency care and out-of-area urgently needed services are covered under the Prime and Custom Plans, anytime, anywhere (worldwide). Any treatment for which there is insufficient evidence of therapeutic value for the use for which it is being prescribed is also not covered. Benefits - Penn Medicine Princeton Health This includes information about our financial condition, about our plan health care providers and their qualifications, about information on our network pharmacies, and how our plan compares to other health plans. Providers | Gmr With discounts averaging 42% for physicians and specialiststhe types of services most typically used with these plansHealth Depot members get more value for their benefit dollars. Be sure to ask your doctors and other providers if you have any questions and have them explain your treatment in a way you can understand. 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. 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). Visit Performance Health HealthworksWellness Portal. Some plans may have deductible requirements. Oops, there was an error sending your message. (SeeOther Benefit Information). Members pay a copayment cost-share for most covered health services at the time the services are rendered. Your right to make complaints If you have questions or concerns about privacy of your personal information and medical records, please call Member Services. No out-of-network coverage unless preauthorized in writing by ConnectiCare. Go > Check provider status Research practitioners and facilities to view their participation status in our provider networks. 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 410 Capitol Avenue, P.O. Choose "Click here if you do not have an account" for self-registration options. No out-of-network coverage unless pre-authorized in writing by ConnectiCare. 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. ConnectiCare also makes available to members printable, temporary ID cards via our website. Medicare and Medicaid eligible members designated as Qualified Medicare Beneficiary. PHCS (Private Healthcare Systems, Inc.) - PPO - Sutter Health ConnectiCare's service area includes all counties. 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. Balance Bill defense is available for all members with a Reference Based Pricing Plan. After the Plan deductible is met, benefits will be covered according to the Plan. Our goal is to be the best healthcare sharing program on the planet and to provide. You may also search online at www.multiplan.com: If you are currently seeing a doctor or other healthcare professional who does not participate in the PHCS Network,you may use the Online Provider Referral System in the Patients section of www.multiplan.com, which allows you tonominate the provider in just minutes using an online form. A 3-day covered hospital stay is not required prior to being admitted. 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). Initial mental health consultation All Practitioners:Please notify ConnectiCare in advance prior to taking any action to remove a specific member from your practice for any reason. Describe the range or medical conditions or procedures affected by the conscience objection; You have the right to an explanation from us about any bills you may get for drugs not covered by our Plan. Read the Membership Agreement, Evidence of Coverage, or other Plan document that describes the Plans benefits and rules. A sample of the ConnectiCare ID cards appear below. PROVIDER PORTAL LOGIN REGISTER NOW Electronic Options: EDI # 59355 Eligibility (270/271) Bill Status (276) Bill Submission (837) For technical assistance with EDI transactions, please contact Change Healthcare at 1-800-845-6592. You have the right to get information from us about our plan. 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. Check Claims & Eligibility Verify patient eligibility and check the status of submitted claims through our online services below. 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. They will be clearly distinguishable by their ID cards. In addition, MultiPlan is not liable for the payment of services under plans. The following is a description of all plan types offered by ConnectiCare, Inc. and its affiliates. Eligibility, Benefits & Claims Assistance, If you dont see the network listed on your ID card please contact our Customer Service at, Please be sure to verify your providers network access with your provider's office directly prior to receiving services. This feature is meant to assist members who need additional copies of their ID card. Bone Mineral Density exams ordered more frequently than every twenty-three (23) months Pharmacy cost-share, if applicable. Your responsibilities as a member of our plan. Preferred Provider Organization Questions? The legal documents that you can use to give your directions in advance in these situations are called "advance directives." In order to maintain permanent residence, a member must not move or continuously reside outside the service area for more than 6 consecutive months. Paying your co-payments/coinsurance for your covered services. Covered at participating urgent care providers. Broker benefits Get in touch. Use our online Provider Portal or call 1-800-950-7040. Remember you will only need your registration code this one time to set up your account. You also have the right to this explanation even if you obtain the prescription drug, or Part C medical care or service from a pharmacy and/or provider not affiliated with our organization. (214) 436 8882 ConnectiCare members may directly access care through self-referral to a participating clinician for covered services and certain Medicare-covered services at designated frequencies and ages, including: Annual routine eye exam (Prime and Custom Plans only) Member Services can also help if you need to file a complaint about access (such as wheel chair access). Your right to get information in other formats PHCS PPO Network - Health Depot Association Keep scheduled appointments or give sufficient advance notice of cancellation. Stress echocardiograms Not condition the provision of care or otherwise discriminate against an individual based on whether or not the individual has executed an advance directive. Enrollee satisfaction with ConnectiCare is very important. (SeeOther Benefit Information). To get any of this information, call Member Services. We are equally committed to you, our PHCS PPO Network, and your overall satisfaction. What insurance carrier is PHCS? - InsuredAndMore.com Call us and tell us you would like a decision if the service or item will be covered. Provide, to the extent possible, information providers need to render care. 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. You will now leave the AvMed web site once you click the "I agree" button. Nuclear cardiology P.O. Member receive in-network level of benefits when they see PHCS Healthy Direction Providers. To pre-notify or to check member or service eligibility, use our provider portal. Member satisfaction with ConnectiCare is very important. Get coverage information. Your right to get information about your prescription drugs, Part C medical care or services, and costs Product and plan details are outlined in the product and coverage section on this page. It is not medical advice and should not be substituted for regular consultation with your health care provider. MRI/MRA (all examinations) No prior authorization requirements. If you want to receive Medicare publications on your rights, you may call and request them at 1-800-MEDICARE (800-633-4227). Please check the privacy statement of the website where this link takes you. I really appreciate the service I received from UHSM. Christian Health Sharing State Specific Notices. The member engages in disruptive behavior. Without preauthorization, these services and procedures may not be covered or may be covered at a reduced rate. Please review the member's ID card to confirm the appropriate phone number. In addition, information is protected by information systems security, and authentication and authorization procedures, such as but not limited to: password-protected files; storage, data disposal, and reuse of media and devices; and transmission and physical security requirements using company-protected equipment including access to devices and media that contain individual-level data. The following is a description of all product types offered by ConnectiCare, Inc. and its affiliates. 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. Routine hearing tests covered up to 1 every year, Routine eye exams covered up to 1 every year, Discounts are available on lenses, contacts and frames. . Question 3. In addition, some of the ConnectiCare plans include Part D, prescription drug coverage. Home health services are coordinated by ConnectiCare's Health Services: To verify benefits and eligibility - (phone) 800-828-3407 Your right to get information about our plan You have the right to receive a detailed explanation from us if you believe that a provider has denied care that you believe you were entitled to receive or care you believe you should continue to receive. UHSM is NOT an insurance company nor is the membership offered through an insurance company. Requests may be made by either the physician or the member. If you need help with communication, such as help from a language interpreter, please call Medicare Member Services. Documents called "living will" and "power of attorney for health care" are examples of advance directives. 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. If you have questions or concerns about your rights and protections, please call Member Services. As a member of a ConnectiCare plan, each individual enjoys certain rights and benefits. If a member tells you that he/she has disenrolled from ConnectiCare, ask where the bill should be sent. You may also call the Office for Civil Rights at 800-368-1019 or TTY:800-537-7697, or your local Office for Civil Rights. Questions regarding the confidentiality of member information may be directed to Provider Services at 877-224-8230. Billing and Claims Eligibility and Benefits Commercial Medicare Product & Coverage Information Overview of Plan Types Overview of plan types The following is a description of all plan types offered by ConnectiCare, Inc. and its affiliates. Ask to see the member's ConnectiCare member identification (ID) card. 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. ConnectiCare provides each member with a statement of member rights and responsibilities. The ID card lists the following information: ConnectiCare member ID number To request a continuation of an authorization forhome health careorIV therapyfax 860-409-2437, All infertility services that are subject to the mandate must be preauthorized, including: a) injectible infertility drugs for the purpose of ovulation induction, b) intrauterine insemination with or without the use of oral or injected medications for ovulation induction, and c) all ART procedures. CommunityCare Life and Health Insurance Company provides an in-network level of benefits for services delivered outside of Oklahoma through a national PPO network, PHCS. ConnectiCare must provide written information to those individuals, including their rights under the law of the State to make decisions concerning their medical care, such as the right to accept or refuse medical or surgical treatment and the right to formulate advance directives. 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. (SeeOther Benefit Information). You may want to give copies to close friends or family members as well. ConnectiCare will maintain such health information and make it available to CMS upon request, as necessary. Yes, PHCS provides coverage for therapy services. 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! Any information provided on this Website is for informational purposes only. Three simple steps and a couple minutes of your time is all it takes to obtain preauthorization from UHSM. precertification on certain services. 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. providers - IBA TPA ConnectiCare requires all of its participating practitioners and providers to treat member medical records and other protected health information as confidential and to assure that the use, maintenance, and disclosure of such protected health information complies with all applicable state and federal laws governing the security and privacy of medical records and other protected health information. You have the right to get information from us about our network pharmacies, providers and their qualifications and how we pay our doctors. When performed out of network, these procedures do require preauthorization. Customer Service number: 877-585-8480. . If you know ahead of time that you are going to be hospitalized, and you have signed an advance directive, take a copy with you to the hospital. I'm a Broker. If you think you have been treated unfairly or your rights have not been respected, you may call Member Services or: If you think you have been treated unfairly due to your race, color, national origin, disability, age, or religion, you can call the Office for Civil Rights at 800-368-1019 or TTY 800-537-7697, or call your local Office for Civil Rights. If you are a PCP, please discuss your provisions for after-hours care with your patients, especially for in-area, urgent care. Provider Portal You can sometimes get advance directive forms from organizations that give people information about Medicare. Box 450978 Westlake, OH 44145. You and your administrative staff can quickly and easily access member eligibility and claims status information anytime, on demand. If your plan does not meet the requirements below, Primary PPO Complementary PPO Specialty Networks Network Management Analytics-Based Solutions: Negotiation Services Medical Reimbursement Note: Some plans may vary. Reference the below Performance Health Open Negotiation Notice for details on the process your provider must follow for disputing the allowable rate used on your claim. All providers shall comply with Title VI of the Civil Rights Act of 1964, as implemented by regulations at 45 C.F.R. For benefit-related questions, call Provider Services at 877-224-8230. HPI | Provider Resources | Patient Benefits & Eligibility ConnectiCare distributes its privacy notice to members annually, and to new members upon enrollment in the plan. Thank you, UHSM, for the excellent customer service experience and the great attitude that is always maintained during calls. How do I contact PHCS? Female members may directly access a women's health care specialist within the network for the following routine and preventive health care services provided as basic benefits: Annual mammography screening (age restrictions apply) Coverage for skilled nursing facility (SNF) admissions with preauthorization. Access to any Medicare-approved doctor or hospital in the United States. It is important to note that not all of the Sutter Health network . Medicare members who elect to become members of ConnectiCare must meet the following qualifications: Members must be eligible for Medicare Part A and be enrolled in and continue to pay for Medicare Part B. PCP name and telephone number Optional Life Insurance *. Phcs Insurance Provider Phone Number | TheWebster Miami Refuse treatment and to receive information regarding the consequences of such action. Answer 5. You may also use the ConnectiCare Eligibility and Referral Line. Your Registration Code is the Alternate ID number on your ID card plus a suffix of 01 for the subscriber, 02, 03, 04, 05, etc for spouse and/or dependents. PHCS (Private Healthcare Systems, Inc.) - Sutter Health You have the right to be told about any risks involved in your care. First, try the Eligibility and Referral Line, If unable to verify, then call Provider Services, (You must participate with Medavant to utilize services). Your right to be treated with dignity, respect and fairness PET scans United Faith Ministries, Inc. is a 501(c)(3) nonprofit corporation, dba Unite Health Share Ministries or UHSM Health Share, that facilitates member-to-member sharing of medical bills. 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. Life Insurance *. Call Automated Phone Specialists between 8 a.m. and 4:30 p.m. (CST) Monday through Fridays at 800-650-6497. What can you doif you think you have been treated unfairly or your rights arent being respected? To get this information, call Member Services. Point-of-Service High Deductible Health Plans have an additional Plan deductible requirement for services rendered by non-participating providers. The plan cannot and will not disenroll a member because of the amount or cost of services used. See preauthorization list for DME that requires pre-authorization. Some applicable copayments 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. Initial chiropractic assessment Question 5. including benefit designs and Sutter provider participation in your provider network. Refer to the annually updated Summary of Benefits section on this page and list of Exclusions and Limitations for more details. If you need assistance If you encounter issues when scheduling appointments with PHCS Network providers, call us at 866-685-7427. Three simple steps and a couple minutes of your time is all it takes to obtain preauthorization from UHSM. The service area includes all counties in Connecticut. Pleasant and provided correct information in a timely manner. All routine laboratory services must be obtained from participating laboratories. After the deductible has been met, coinsurance will apply to the covered benefits. We believe there is no such thing as a standard cost management approach. If you need more information, please call Member Services. That goes for you, our providers, as much as it does for our members. Prior Authorizations are for professional and institutional services only. Additionally, ConnectiCaremaydisenroll a member if: Premiums are not paid on a timely basis. Reminding the patient to notify ConnectiCare; and drug, biological or venom sensitivity. It is critical that the members eligibility be checked at each visit. If a complaint about you or your office staff is received, ConnectiCare will contact you and request information relating to the complaint. While you may contact us by telephone, you will be asked to place your concerns in writing. You have the right to get full information from your providers when you go for medical care, and the right to participate fully in decisions about your health care. Please also be sure to follow any preauthorization procedures required by your plan(usually a telephone number on your ID card). If you want to have an advance directive, you can get a form from your lawyer, from a social worker, or from some office supply stores. If you have questions about your benefits or the status of claims, please call Group Benefit Services, Inc. When scheduling your appointment, specify that you have access to the PHCS Network throughthe HD Protection Plus Plan, confirm the providers current participation in the PHCS Network, their address and thatthey are accepting new patients. Understand their health problems and participate in developing mutually agreed upon treatment goals to the degree possible. PDF PHCS Savility - MultiPlan UHSM medical sharing eligibility extends to qualifying costs at the more than 1.2 million doctors, hospitals, and specialists in this network. In addition, to ensure proper handling of your claim, always present yourcurrent benefits ID card upon arrival at your appointment. ConnectiCare cannot reverse CMS' determination. A PHCS logo on your health insurance card tells both you and yourprovider that a PHCS discount applies. The PHCS Network is designed to be used with limited benefit plans that offer a higher level of coverage. CT scans (all diagnostic exams) abnormal MRI; and 2.) Be treated with respect and recognition of your dignity and right to privacy. The provider must agree to accept network rates for the defined period of time. In addition, some of the ConnectiCare plans include Part D, prescription drug coverage. Some plans may have a copayment requirement for radiology services. This includes information about our financial condition, and how our Plan compares to other health plans. ConnectiCare will also notify members of the change thirty (30) days prior to the effective date of the change, or as soon as possible after we become aware of the change. You are now leavinga ConnectiCare website. Minimal hold time Fast Claim Processing and Payment Clear Explanation of Benefits Clear Benefit Descriptions Members of PHCS health insurance plans have mental health benefits, which vary based on the plan under which they're enrolled. Information is protected as outlined in ConnectiCare's policies. You can reference your plan document for the complete list. These services are covered under the Option Plan nationwide. As of January 1, 2023, the Transparency in Coverage Rule mandates member access to a healthcare price comparison tool. The following are samples of each type of ID card that ConnectiCare issues to members. Providers shall not discriminate against an enrollee based on whether or not the enrollee has executed an advance directive. Multiplan or PHCS | Mental Health Coverage | Zencare Zencare Colorectal screening (age restrictions apply) Members > MultiPlan Your benefits, claims and/or eligibility are available 24/7 via our member portal. In these cases, you must request an initial decision called an organization determination or a coverage determination. Provider Page | Medi-Share ConnectiCare members must continue to pay the Medicare Part B premium directly to the Medicare program. We will make sure that unauthorized people dont see or change your records. Document in a prominent part of the individual's current medical record whether or not the individual has executed an advance directive; and PHCS PPO Network - WeShare Healthcare To verify or determine patient eligibility, call 1-800-222-APWU (2798). 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. There are different types of advance directives and different names for them. The provider must agree to accept network rates for the defined period of time. What does Transition of Care and Continuity of Care mean? In-office procedures are restricted to a specific list of tests that relate to the specialty of the physician. The sample ID cards are for demonstration only. How to get more information about your rights There are federal and state laws that protect the privacy of your medical records and personal health information. Answer 3. You have the right to an explanation from us about any prescription drugs or Part C medical care or service not covered by our plan. You should consider having a lawyer help you prepare it. It is important to sign this form and keep a copy at home. Eligibility and Benefits | ConnectiCare
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