Balance Bill defense is available for all members with a Reference Based Pricing Plan. UHSM Providers - PHCS PPO Network Question 3. For concerns or problems related to your Medicare rights and protections described in this section, you may call our Member Services. Participate with practitioners in decision-making regarding your health care. Benefits Administration and Member Support for The Health Depot Association is provided byPremier Health Solutions. 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. Virtual colonoscopy for diagnostic purposes only, as determined by medical necessity criteria (CPT code 0067T). Some plans may have a copayment requirement for radiology services. For additional details on using ConnectiCare's Eligibility & Referral Line or Medavant, refer toAutomated & Online Features. Simplifying the benefits experience, so you can focus on patient care. When you complete the form, MultiPlan will contact yournominee to determine whether the provider is interested in joining. If so, they will follow up to recruit the provider. 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. Follow the plans and instructions for care that they have agreed on with practitioners. Broker benefits Get in touch. Discounts on frames, lenses, and contact lenses: 25% discount for items costing $250 or less; 30% discount for items over $250. TTY users should call 877-486-2048. In order to maintain permanent residence, a member must not move or continuously reside outside the service area for more than 6 consecutive months. You have the right to an explanation from us about any bills you may get for services not covered by our plan. 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. It is critical that the members eligibility be checked at each visit. Questions regarding the confidentiality of member information may be directed to Provider Services at 877-224-8230. ConnectiCare Medicare Advantage plans include a number of Medicare Advantage Plans. Coverage is provided for temporomandibular joint (TMJ) surgery or orthognathic procedures with preauthorization, when medical necessity is established. Phcs Insurance Provider Phone Number | TheWebster Miami For more information regarding complaint resolution, contact Provider Services at 877-224-8230. Question 1. They are collected via enrollment information, self-disclosure, and the member portal. 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 LimitedBenefit plans. Medicare and Medicaid eligible members designated as Qualified Medicare Beneficiary. In these cases, you must request an initial decision called an organization determination or a coverage determination. Actual copayment information and other benefit information will vary. 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) Most plans exclude purely dental services, including oral surgery, but benefits vary by employer. 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. The temporary card is a valid form of ConnectiCare member identification. Choose "Click here if you do not have an account" for self-registration options. All oral medication requests must go through members' pharmacy benefits. 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. Stress echocardiograms Our plan must obey laws that protect you from discrimination or unfair treatment. You may want to give copies to close friends or family members as well. Examples of covered medical conditions can be found below. PHCS www.multiplan.com (Please select the provider network listed on your ID card) Pay applicable copayments, deductibles or coinsurance. Remember you will only need your registration code this one time to set up your account. The right to know how information about race, language, ethnicity, gender orientation, and sexual identity are collected and used. The plan cannot and will not disenroll a member because of the amount or cost of services used. ConnectiCare, in compliance with advance directives regulations, must maintain written policies and procedures concerning advance directives with respect to all adult individuals receiving medical care. (More information appears later in this section.). ConnectiCare will communicate to your patients how they may select a new PCP. UHSM is a different kind of healthcare, called health sharing. Refer to the annually updated Summary of Benefits section on this page and list of Exclusions and Limitations for more details. 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. We have partnered with TALON to bring you access to MyMedicalShopper; which provides you the ability to shop for healthcare services based on price, quality, and location. If you have questions or concerns about privacy of your personal information and medical records, please call Member Services. That goes for you, our providers, as much as it does for our members. 1-1/2 times your annual salary paid to your beneficiary in the event of your death. Question 5. If you have questions or concerns about your rights and protections, please call Member Services. 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. 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. Provider. You may also search online at www.multiplan.com: Click on the Search for a Doctor or Facility button We hope that our members are satisfied and decide to stay with ConnectiCare; however, should you learn that a member plans to disenroll, you may avoid payment delays by: 1. 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. 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. This video explains it. A candid discussion of appropriate or medically necessary treatment options for your condition, regardless of cost or benefit coverage. For Medicaid managed Prostate cancer screening (age restrictions apply) Your right to see plan providers, get covered services, and get your prescriptions filled within a reasonable period of time 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! 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. Note: These procedures are covered procedures, but do not require preauthorization when performed by in-network providers. Your responsibilities as a member of our plan. The ConnectiCare Medicare Advantage network. Network providers and practitioners are also contractually obligated to protect the confidentiality of members information. 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). Use the My Plan tab on the main website page to register for online access to your claims, plan document, EOBs and additional items. abnormal arthrogram. When performed out of network, these procedures do require preauthorization. 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. Below are the additional benefits covered by ConnectiCare. Visit our other websites for Medicaid and Medicare Advantage. Members pay a copayment as cost-share for most covered health services at the time services are rendered. Providers shall not discriminate against an enrollee based on whether or not the enrollee has executed an advance directive. You have chosen PHCS (Private Healthcare Systems, Inc.). What can you doif you think you have been treated unfairly or your rights arent being respected? Your plan does require Testing that exceeds this maximum is the members responsibility. You can easily: Verify member eligibility status; . You will now leave the AvMed web site once you click the "I agree" button. Without preauthorization, these services and procedures may not be covered or may be covered at a reduced rate. Provider Portal Eligibility inquiry Claims inquiry. Out of network benefits will apply when receiving care from non-participating providers. Clinical Review Prior Authorization Request Form. ConnectiCare limits and terminates access to information by employees who are not or no longer authorized to have access. PHCS Health Insurance is Private HealthCare Systems, and was recently acquired by MultiPlan. The admitting physician is responsible for pre-authorizing elective admissions five (5) working days in advance. 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. If you need help with communication, such as help from a language interpreter, please call Medicare Member Services. Members have an in-network deductible for some covered services. UHSM serves as a connector, we administer the cost-sharing program and help health share members support each otherits AWESOME! Employer group enrollment will be the result of employers electing to offer benefits to retirees through ConnectiCare. With the PHCS Network in your cost management strategy, you give your health plan participants the choice of over 4,100 hospitals, 70,000 ancillary care facilities and 630,000 healthcare professionals nationwide, whether they seek care in their home town or across the country. (214) 436 8882 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. The member loses entitlement to Medicare Parts A and/or B. 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. Customer Service at 800-337-4973 In-office procedures are restricted to a specific list of tests that relate to the specialty of the provider. Answer 3. 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. Nutritionist and social worker visit Preferred Provider Organization Questions? Its affordable, alternative health care. Members who develop ESRD after enrollment may remain with a ConnectiCare plan. If you need assistance If you encounter issues when scheduling appointments with PHCS Network providers, call us at 866-685-7427. Referrals must be signed in to ConnectiCaresProvider Connection. Voice complaints or appeals/grievances about us or the care you are provided. We also cover additional benefits beyond Original Medicare alone. 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. abnormal MRI; and 2.) 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. Keep scheduled appointments or give sufficient advance notice of cancellation. PHCS is a large health insurance company with a wide range of plan types, therefore the amount of coverage ranges. 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. (SeeOther Benefit Information). You must be told in advance if any proposed medical care or treatment is part of a research experiment, and be given the choice of refusing experimental treatments. Your benefits, claims and/or eligibility are available 24/7 via our member portal. For more information regarding complaint resolution, contact Provider Services at 860-674-5850 or 800-828-3407. 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. Just like we shop for everything else! (SeeOther Benefit Information). Check with our Customer Service Team to find out if your plan accesses Health Coaching. Your right to use advance directives (such as a living will or a power of attorney) After the Plan deductible is met, benefits will be covered according to the Plan. Not condition the provision of care or otherwise discriminate against an individual based on whether or not the individual has executed an advance directive. 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. Benefit Type* Subscriber SSN or Card ID* Patient First Name Patient Gender* Male Female Patient Date of Birth* Provider TIN or SSN*(used in billing) SeeGlossaryfor definitions of emergency and urgent care. Life Insurance *. Information is protected as stated in ConnectiCares policies. To determine copayment requirement, call ConnectiCare's Eligibility & Referral Line at 800-562-6834. PHCS Health Insurance - Health Insurance Providers Use your member subscriber ID to access the pricing tool using the link below. As a member of a ConnectiCare plan, each individual enjoys certain rights and benefits. To get any of this information, call Member Services. 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. This includes the right to leave a hospital or other medical facility, even if your doctor advises you not to leave. You must call ConnectiCares Notification Line at 860-674-5870 or 888-261-2273 to advise ConnectiCare of the admission. You have the right to get a summary of information about the appeals and grievances that members have filed against our plan in the past. No referrals needed for network specialists. If a member tells you that he/she has disenrolled from ConnectiCare, ask where the bill should be sent. 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). Please refer to your Membership Agreement, Certificate of Coverage, Benefit Summary, or other plan documents for specific information about your benefits coverage. When in the service area, members are expected to seek routine services, except for certain self-referred services, from their PCP. 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) Medicare Advantage or Medicaid call 1-866-971-7427. While we strive to keep this list up to date, it's always best to check with your health plan to determine the specific details of your coverage, including benefit designs and Sutter provider participation in your provider network. Circumstances beyond our control such as complete or partial destruction of facilities, war, or riot. Medicare providers under their ConnectiCare contract are required to see all ConnectiCare VIP Medicare Plan members including those who are dual eligible for Medicare and Medicaid. 410 Capitol Avenue Prior Authorizations are for professional and institutional services only. This feature is meant to assist members who need additional copies of their 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. Provider Portal Info > MultiPlan ConnectiCare, in coordination with participating providers, will maintain and monitor the network of participating providers to ensure that members have adequate access to PCPs, specialists, hospitals, and other health care providers, and that through the network of providers their care needs may be met. Members are required to see participating providers, except in emergencies. Some plans cover preventive dental services: Receive information about us, our services, our participating providers, and "Members Rights and Responsibilities.". All oral medication requests must go through members' pharmacy benefits. PHCS Network | AvMed All oral medication requests must go through members' pharmacy benefits. SeeMedical Management. * ConnectiCare reserves the right to use third-party vendors to administer some benefits, including utilization management services. We request your cooperation in investigating and resolving these complaints. Your right to get information about our plan and our network pharmacies 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. New Century Health - Medical Oncology Policies, Provider resource: 2020 changes to Medicare Advantage plans, Dual special needs plan member information available through provider website, Reminders about caring for our Medicare Advantage members, Changes to claims payment for Medicare Advantage inpatient stays, Update on Medicare Beneficiary Identifiers (MBIs), Clinical Review Prior Authorization Request Form. If you do, please call Member Services. Your right to get information about our plan Multiplan or PHCS | Mental Health Coverage | Zencare Zencare Emergency care is covered. Enrollee satisfaction with ConnectiCare is very important. Asking at the time of each visit if he/she is still enrolled in a ConnectiCare plan. Submit a Coverage Information Form. Member receive in-network level of benefits when they see PHCS Healthy Direction Providers. To get this information, call Member Services. 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. It is your responsibility to confirm your provider or facilitys continued participation in the PHCS Network and accessibilityunder your benefit plan. Transition of Care allows new members and/or members whose plan has experienced a recent provider network change to continue to receive services for specified medical and behavioral conditions, with health care professionals that are not participating in the plans designated provider network, until the safe transfer of care to a participating provider and/or facility can be arranged. The following are samples of each type of ID card that ConnectiCare issues to members. 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. You and your administrative staff can quickly and easily access member eligibility and claims status information anytime, on demand. 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. A sample of the ConnectiCare ID cards appear below. ConnectiCare Medicare Advantage plans provide all Part A and Part B benefits covered by Original Medicare. To obtain a copy of the privacy notice, visit our website atconnecticare.com, or call Provider Services at the number below. Regardless of where you get this form, keep in mind that it is a legal document. These extra benefits include, but are not limited to, vision, dental, hearing, and preventive services, like annual physicals. Solutions. Such information includes, but is not limited to, quality and performance indicators for plan benefits regarding disenrollment rates, enrollee satisfaction, and health outcomes. You can also get help from CHOICES - your State Health Insurance Assistance Program, or SHIP. Box 340308, Hartford, CT 06134-0308, 860-509-8000, TTY: 860-509-7191. For example, you have the right to look at medical records held at the plan, and to get a copy of your records. Benefit Type* Subscriber SSN or Card ID* Subscriber Group #* Patient First Name Patient Gender* Male Female Patient Date of Birth* Provider TIN or SSN*(used in billing) UHSM is NOT an insurance company nor is the membership offered through an insurance company. ConnectiCare distributes its privacy notice to members annually, and to new members upon enrollment in the plan. On a customer service rating I would give her 5 golden stars for the assistance I received. You have the right to refuse treatment. SISCO's provider portal allows you to submit claims, check status, see benefits breakdowns, and get support, anytime. Copyright 2022 Unite Health Share Ministries. Be treated with respect and recognition of your dignity and right to privacy. Ask to see the member's ConnectiCare member identification (ID) card. 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. 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. This would also include chronic ventilator care. MultiPlan can help you find the provider of your choice. Pleasant and provided correct information in a timely manner. Identify the state legal authority permitting such objection; 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 For plans where coverage applies, one routine eye exam per year covered at 100% after copayment (no referral required). ThriveHealth STM - Health Depot Association If you have questions about your benefits or the status of claims, please call Group Benefit Services, Inc. We are equally committed to you, our PHCS PPO Network, and your overall satisfaction. To pre-notify or to check member or service eligibility, use our provider portal. 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. For benefit-related questions, call Provider Services at 877-224-8230. UHSM is not insurance. Optional Life Insurance *. 860-509-8000, (TTY) 860-509-7191. The member provides fraudulent information on the application or permits abuse of an enrollment card. 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. To get this information, call Member Services. Eligibility and Referral Line If you have any concerns about your health, please contact your health care provider's office. PHCS (Private Healthcare Systems, Inc.) - PPO. The rental and/or purchase of CPAP and BI-PAP machines must be done through our preferred vendors. 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. 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. You have the right to choose a plan provider (we will tell you which doctors are accepting new patients). Pelvic exam Product and plan details are outlined in the product and coverage section on this page. Payors > MultiPlan Your right to get information in other formats Get coverage information. Please refer to your Membership Agreement, Certificate of Coverage, Benefit Summary, or other plan documents for specific information about your benefits coverage. Initial chiropractic assessment 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. PHC's Member Services Department is available Monday - Friday, 8 a.m. - 5 p.m. You can call us at 800 863-4155. 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. A new web site will open up in a new window. ConnectiCare's service area includes all counties. You have the right to timely access to your prescriptions at any network pharmacy.
phcs eligibility and benefits