Mail Paper HCFAs or UBs: Medi-Share Documents called "living will" and "power of attorney for health care" are examples of advance directives. PHCS is the leading PPO provider network and the largest in the nation. If you do not inform ConnectiCare according to these guidelines, the SNF may not receive payment for any additional days of the member's stay. 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. UHSM serves as a connector, we administer the cost-sharing program and help health share members support each otherits AWESOME! If you want a paper copy of this information, you may contact Provider Services at 860-674-5850 or 800-828-3407. 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. Call us and tell us you would like a decision if the service or item will be covered. 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. The admitting physician is responsible for preauthorizing elective admissions five (5) working days in advance. Member eligibility Medicaid managed care and Medicare Advantage plan effective dates Note: MultiPlan does not have access to payment records and does not make determinations with respect to ben-efits or eligibility. Prior Authorizations are for professional and institutional services only. Question 3. Colorectal screening (age restrictions apply) Providers shall not discriminate against an enrollee based on whether or not the enrollee has executed an advance directive. Healthcare Provider FAQs > MultiPlan Contact us. ConnectiCare members must continue to pay the Medicare Part B premium directly to the Medicare program. Members are encouraged to actively participate in decision-making with regard to managing their health care. Once you have completed the Registration form you will be emailed a link to confirm your Registration. 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. 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 Answer 2. Some plans may have a copayment requirement for radiology services. You also have the right to get information from us about our plan. Coverage follows Original Medicare guidelines. MedAvant PHCS Health Insurance is Private HealthCare Systems, and was recently acquired by MultiPlan. 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. Performance Health at 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. Provider - SisCo Wondering how member-to-member health sharing works in a Christian medical health share program? This line is available twenty-four (24) hours a day, seven days a week. Visit our other websites for Medicaid and Medicare Advantage. Use your member subscriber ID to access the pricing tool using the link below. Note: Some plans may have different benefits/limits; refer members to Member Services for verification at 800-251-7722. If you need more information, please call Member Services. 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. 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. We must investigate and try to resolve all complaints. ConnectiCare eligible members shall not be discriminated against with respect to the availability or provision of health services based on an enrollee's race, sex, age, religion, place of residence, HIV status, source of payment, ConnectiCare membership, color, sexual orientation, marital status, or any factor related to an enrollee's health status. To begin the precertification process, your provider(s) should contact, Transition and Continuity of Care - Information and Request Form, Performance Health Open Negotiation Notice. Read the Membership Agreement, Evidence of Coverage, or other Plan document that describes the Plans benefits and rules. It is important to sign this form and keep a copy at home. Your right to get information about your drug coverage and costs 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. Oops, there was an error sending your message. ConnectiCare provides each member with a statement of member rights and responsibilities. Covered according to Massachusetts state mandate. That goes for you, our providers, as much as it does for our members. Provider Portal Info > MultiPlan PET scans Your right to be treated with dignity, respect and fairness TTY users should call 877-486-2048. Paying your co-payments/coinsurance for your covered services. You have the right to timely access to your providers and to see specialists when care from a specialist is needed. Without preauthorization, these services and procedures may not be covered or may be covered at a reduced rate. There are different types of advance directives and different names for them. DME, orthotics & prosthetics must be obtained from a participating commercial DME vendor unless otherwise authorized by ConnectiCare and pre-authorization must be obtained through ConnectiCare. Best of all, it's free- no downloads required or software to install. DME, orthotics & prosthetics must be obtained from a participating commercial DME vendor unless otherwise authorized by ConnectiCare and preauthorization must be obtained through ConnectiCare. Members must meet an in-network Plan deductible that applies to most covered health services, including prescription drug coverage, before coverage of those benefits apply. info@healthdepotassociation.com, Copyright © 2023 Health Depot Association, All Rights Reserved, Supplemental Accident and/or Critical Illness, Follow the prompts to enter your search criteria. Note: To ensure accurate billing for plans with deductibles, bill ConnectiCare prior to taking any payment from members. Balance Bill defense is available for all members with a Reference Based Pricing Plan. 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. 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. ConnectiCare cannot reverse CMS' determination. ConnectiCare enrolls individual members into the ConnectiCare plan. 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. Member satisfaction information is updated and posted annually and is made available on our website atconnecticare.com. Nuclear cardiology We must tell you in writing why we will not pay for or approve a service, and how you can file an appeal to ask us to change this decision. For non-portal inquiries, please call 1-800-950-7040. 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. Quality - MultiPlan applies rigorous criteria when credentialing providers for participation in the PHCSNetwork, so you can be assured you are choosing your healthcare provider from a high-quality network. 2. Renal dialysis services for members temporarily outside the service area. If you want a paper copy of this information, you may contact Provider Services at 877-224-8230. drug, biological or venom sensitivity. Some plans cover preventive dental services: Receive information about us, our services, our participating providers, and "Members Rights and Responsibilities.". Medical claims can be sent to: Insurance Benefit Administrators, c/o Zelis, Box 247, Alpharetta, GA, 30009-0247; EDI Payor ID: 07689. Contact the pre-notification line at 866-317-5273. It is important to note that not all of the Sutter Health network . The PHCS Network is designed to be used with limited benefit plans that offer a higher level of coverage. Monitoring includes member satisfaction with physicians. Enrollee satisfaction information is updated and posted each December and is made available on our website at www.connecticare.com. Some preventive services are covered at 100% and are exempt from the deductible requirement. Answer 3. When performed out-of-network, these procedures do require preauthorization. Providers are responsible for seeking reimbursement from members who have terminated if the services provided occurred after the member's termination date. Timely access means that you can get appointments and services within a reasonable amount of time. 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. Note: Presentation of a member ID card is not a guarantee of a member's eligibility. Customer Service number: 877-585-8480. . Eligibility and Referral Line You can easily: Verify member eligibility status; . Christian Health Sharing State Specific Notices. If you are a PCP, please discuss your provisions for after-hours care with your patients, especially for in-area, urgent care. To verify or determine patient eligibility, call 1-800-222-APWU (2798). That goes for you, our providers, as much as it does for our members. All oral medication requests must go through members' pharmacy benefits. Advance directives are written instructions, such as living will, durable power of attorney for health care, health care proxy, or do not resuscitate (DNR) request, recognized under state law and relating to the provision of health care when the individual is incapacitated and unable to communicate his/her desires. Coverage is provided for temporomandibular joint (TMJ) surgery or orthognathic procedures with preauthorization, when medical necessity is established. Members who do not have an ID card should not be denied medical services without contacting ConnectiCare first to determine the member's enrollment status. ConnectiCare requires that sufficient notice be given to all of your patients affected by a change in your practice. 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. P.O. ConnectiCare Medicare Advantage plans include a number of Medicare Advantage Plans. Your right to make complaints Blue Cross Providers: 800 . Lifetime maximums apply to certain services. Devices can include but not be limited to diskettes, CDs, tapes, mobile applications, portable drives, desktops, laptops, secure portals, and hardware. 100 Garden City Plaza, Suite 110 Garden City, NY 11530. sales@ibatpa.com. Member receive in-network level of benefits when they see PHCS Healthy Direction Providers. We must tell you in writing why we will not pay for a drug, and how you can file an appeal to ask us to change this decision. You may want to give copies to close friends or family members as well. UHSM is always eager and ready to assist. Claims or Benefits questions will not be answered here. 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. This report is sent to all PCPs upon request, and it lists each member who has selected or has been assigned to that PCP. Understand their health problems and participate in developing mutually agreed upon treatment goals to the degree possible. This feature is meant to assist members who need additional copies of their ID card. Members pay a copayment as cost-share for most covered health services at the time services are rendered. We are a caring community dedicated to keeping our members healthy, happy, and in control of their well-being. For emergency care received outside the U.S. there is a $100,000 limit. HPI | Provider Resources | Patient Benefits & Eligibility Three simple steps and a couple minutes of your time is all it takes to obtain preauthorization from UHSM. Refuse treatment and to receive information regarding the consequences of such action. Box 340308, Hartford, CT 06134-0308, 860-509-8000, TTY: 860-509-7191. 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. You will be contacted by Insurance Benefit Administrators regarding final pricing for the claims submitted in the weeks following submission. If a member tells you that he/she has disenrolled from ConnectiCare, ask where the bill should be sent. When performed out of network, these procedures do require preauthorization. Please note: MultiPlan, Inc. and its subsidiaries are not insurance companies, do not pay claims and do not guaranteehealth benefit coverage. part 91; other laws applicable to recipients of federal funds; and all other applicable laws and rules, are required by applicable laws or regulations. We request your cooperation in investigating and resolving these complaints. For Medicaid managed Check Claims & Eligibility Verify patient eligibility and check the status of submitted claims through our online services below. Information is protected as stated in ConnectiCares policies. Sometimes, people become unable to make health care decisions for themselves due to accidents or serious illness. By contracting with this network, our members benefit from pre-negotiated rates and payment processes that lead to a much smoother . Bone Mineral Density exams ordered more frequently than every twenty-three (23) months Our goal is to be the best healthcare sharing program on the planet and to providean AWESOME*experience, every time! Provider. ConnectiCare members are entitled to an initial assessment of their health care status within ninety (90) days of enrollment in the Plan. First, try the Eligibility and Referral Line, If unable to verify, then call Provider Services, (You must participate with Medavant to utilize services). Minimal hold time Fast Claim Processing and Payment Clear Explanation of Benefits Clear Benefit Descriptions 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. To determine copayment requirement, call ConnectiCare's Eligibility & Referral Line at 800-562-6834. After the deductible has been met, coinsurance will apply to the covered benefits. If your plan does not meet the requirements below, Primary PPO Complementary PPO Specialty Networks Network Management Analytics-Based Solutions: Negotiation Services Medical Reimbursement Members have an in-network deductible for some covered services before coverage for the benefits will apply. Question 4. PHCS is a large health insurance company with a wide range of plan types, therefore the amount of coverage ranges. We must investigate and try to resolve all complaints. 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. A sample of the ConnectiCare ID cards appear below. 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. your current benefits ID card upon arrival at your appointment. You must apply for Transition of Care no later than 30 days after the date your coverage becomes effective or after the effective date of the network change using the request form below. No out-of-network coverage unless preauthorized in writing by ConnectiCare. UHSM is not insurance. For example, you have the right to look at medical records held at the plan, and to get a copy of your records. We conduct routine, focused surveys to monitor satisfaction using the Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey and implement quality improvement activities when opportunities are identified. 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 ask someone such as a family member or friend to help you with decisions about your health care. 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. Performance Health Bone mass measurement This video explains it. What insurance carrier is PHCS? - InsuredAndMore.com Provider Portal Eligibility inquiry Claims inquiry. Just like we shop for everything else! Browse the list to see where your plan is accepted. 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. All oral medication requests must go through members' pharmacy benefits. 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. 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. 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! There are federal and state laws that protect the privacy of your medical records and personal health information. If you have any other kind of concern or problem related to your Medicare rights and protections described in this section, you can also get help from CHOICES. You may want to give copies to close friends or family members as well. PHC's Member Services Department is available Monday - Friday, 8 a.m. - 5 p.m. You can call us at 800 863-4155. Prior Authorizations are for professional and institutional services only. Customer Service at 800-337-4973 Discounts on frames, lenses, and contact lenses: 25% discount for items costing $250 or less; 30% discount for items over $250. PDF PHCS Network and Limited Benefit Plans - MultiPlan
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